Code Status? Critically Evaluating Canadian ‘Do Not Attempt Resuscitation’ (DNAR) Orders

Abstract

In this project, I explore and critically evaluate the theory, practical value, and accessibility of ‘do-not-attempt-resuscitation’ (DNAR) orders as they exist in the Canadian healthcare context. I first explain how DNAR orders developed in response to the standardization of in-hospital resuscitation practices. I begin my analysis by examining the bioethical concepts of presumed consent and medical futility, which frame the modern CPR/DNAR debate. I demonstrate how typical applications of these concepts may lead to the compromising of prevalent principles of healthcare ethics they are intended to uphold. I then introduce and describe the problem of overintervention in end-of-life care that is facilitated by default systems of presumed consent to CPR and is challenged by patients’ and substitute decision-makers’ DNAR orders. Finally, I describe and suggest solutions for potential barriers to DNAR accessibility that limit Canadian patients’ ability to refuse and prevent overintervention in their end-of-life care.