Do-Not-Resuscitate Decision / 拒绝心肺复苏决定

Definition

A do-not-resuscitate decision is a treatment-limit choice not to initiate cardiopulmonary resuscitation after cardiac or respiratory arrest; it does not by itself mean stopping all treatment, nursing, symptom relief, or human support.

Current Synthesis

The wiki treats DNR as one bounded part of goals-of-care planning rather than a synonym for 安宁疗护, discharge, abandonment, or euthanasia. The source places it inside prognosis discussion, patient preference where decision-making capacity remains, surrogate and family communication where it does not, and continuing reassessment as symptoms and emotions change. A family case in which an initial DNR and home plan changes to intubation and sedation under visible respiratory distress shows why documentation does not eliminate fear, uncertainty, or the need for renewed explanation.

Key Claims

• DNR limits cardiopulmonary resuscitation; it does not automatically withdraw every other form of care.
• The choice should be connected to prognosis, expected benefit and burden, patient wishes, and the wider goals of treatment.
• Patient preference has priority when the patient can understand and express a decision; surrogate involvement becomes central when capacity is absent.
• Decisions can be revisited when clinical state, distress, understanding, or family judgment changes.
• DNR discussion belongs inside continuing communication and symptom control rather than a one-time signature event.

Evidence

• Scope and purpose: VOL.44献礼护士节｜与协和医院护师对谈临终关怀中的“身、心、社、灵” presents DNR as avoiding burdensome resuscitation within end-of-life care, not as active life-ending action.
• Decision pathway: VOL.44献礼护士节｜与协和医院护师对谈临终关怀中的“身、心、社、灵” prioritizes an informed patient’s wishes and otherwise describes ongoing family communication.
• Reversibility under pressure: VOL.44献礼护士节｜与协和医院护师对谈临终关怀中的“身、心、社、灵” recounts a family changing from DNR and home discharge to intubation and sedation after seeing severe breathing distress.

Counterevidence & Qualifications

One family narrative cannot establish how often DNR decisions change or what the best choice was. Capacity, authority, documentation, emergency applicability, resuscitation outcomes, sedation, withdrawal, and surrogate rules vary by condition, institution, and jurisdiction. DNR decisions require qualified local clinical and legal processes, and the source does not supply an operational protocol.

What Changed

• Established DNR as a narrow resuscitation decision rather than a complete end-of-life plan.
• Added revisability under changing clinical and emotional conditions to the current judgment.

Related Concepts

• 安宁疗护 / Hospice Care - broader comfort-focused care within which a DNR choice may occur.
• End-of-Life Autonomy And Dignity - patient-agency basis for treatment-limit decisions.
• Family Ethics At End Of Life - surrogate, grief, and disagreement context when families participate.
• Intensive Care as Time-Buying - reversibility and expected-benefit boundary for organ support.
• Death Normalization Practice / 死亡日常化练习 - advance conversation that can make later decisions more discussable.