Deciding not to resuscitate. Responsibilities of physicians and nurses--a proposal.

After discussing the decision with the staff, physicians should investigate the conditions for a do-not-resuscitate (DNR) order, make the decision, and inform the patient and the family. But, according to the present and other studies, they are not taking the full responsibility for these tasks. Nurses are supposed to participate in the discussions with the physicians prior to a DNR decision, but not to make the decision or to inform the patient and the family. Physicians and nurses have different opinions about their legitimate roles when DNR orders are initiated and made. However, 8% of the nurses in the present study state that they have made a DNR decision and 37% declare that the nurse should do so. We propose a model where the skills of the responsible physician (to make the diagnosis and prognosis) and the skills of the responsible nurse (to communicate with the patients by virtue of their close relationship) are combined. Accordingly, future guidelines should stress the joint responsibility of physicians and nurses to investigate the conditions precedent for a DNR order, to make the DNR decision, and to inform the patients and the family.