DORES: Do-Not-Resuscitate orders by people with Suicidal Ideations

A Do-Not-Resuscitate (DNR) order is a form of advance care planning and a way to communicate a patient’s treatment refusal when they are in need of cardiopulmonary resuscitation (CPR) and therefore unconscious. Although widely accepted and implemented, detailed regulation is often lacking and complex dilemmas regularly occur in clinical practice. Patients with suicidal ideations seem to be increasingly drafting DNR orders. This can lead to challenging and morally distressing situations for all parties involved. If a health care professional successfully performs CPR, the patient afterwards may have residual complaints and feel that their autonomy is violated. If a DNR order is followed that is drafted during a transient suicidal state that does not reflect the true choice of the patient, the preventable loss of life can be seen as a tragedy in itself, but may also be harmful to the relatives. Research on this topic is scarce, and there are currently no guidelines or clear policies to guide this encounter.