Due to the advance of scientific and medical technology, life expectancy has been dramatically increased, the number of people suffering chronic disease have been increasing. In consequence, DNR (Do-Not-Resuscitate) orders are made by frequently in hospitals. In Korea, however, DNR decisions are often made by doctors' and family member without refering to patients' own will. It is because criteria or guidelines of DNR have not been clasified in the medical community. Moreover, the scope of specific treatments for patients is not agreed to even among doctors, leaving a room for disputes, so it is deemed urgent to arrange some DNR guidelines. In such circumstances, this study is aimed at examining the DNR orders against cancer patients not only in ethical terms, but also in empirical terms, examining the cases about DNR orders. It tries to establish a set of criteria and procedures for DNR decisions appropriate to medical and ethical situations in Korea.
In order to understand the characteristics of cancer patients subject to DNR orders, this thesis examines 60 patients hospitalized at the intensive care unit of a cancer special hospital to be subject to CPR, and then, selects twenty three patients against whom the DNR were ordered. It, examines their medical records, observed the conditions. I have also conducted interviews with them and in addition to such qualitative methods, used the descriptive statistical method.
The results of this study can be summarized as follows;
First, the demographic variables of the cancer patients against whom the DNR decisions were made can be summed up as below;
DNR decisions were made most to those patients in their 50's, most of whom were terminal cancer patients. Out of 60 patients subject to CPR, twenty three patients were left with DNR decisions, and as a result of CPR, 48.3%(n=29) died, while only 13.% of patients(n=5) survived. The primary reasons for DNR decision were failures of organic functions, metastasis of cancer into organs, flickering or inactivated mental state. At the time of DNR decisions, most of the patients were at the state of coma, and 52.2% of DNR decisions were made for less than a week when the patients' death was impending medically. In most cases, patients eventually died.
Second, with respect to DNR decisions of cancer patient's, this research has found followings.
In most cases, doctors and guardians participated in DNR decisions, often without referring to patients own will. Normally, doctors took initiative in decision making, briefing and invited patients' spouses or eldest sons to DNR orders. Such a briefing was made mostly at the time of the hospitalization terminally ill cancer patient's or their transfer to the intensive care unit due to their critical conditions.
Thirdly, DNR decisions were made when the conditions of patients deteriorated critically. and CPR would only harm well-being of the patients. Financial burden of the family and human way passing final time of life were also considered.
Fourthly, in response to the question "Were you requested in written to agree to the DNR decisions?", the majority(60.9%) of the guardians answered that they had been requested verbally by physicians, while only 26.1% of them could agree to DNR decisions in written.
In conclusion, this research found that it is deemed essential to develop a measurement in which it will allow hospitals and families of patient's for DNR decisions. To avoid any ethical and legal dispute regarding DNR. This research suggests that hospitals and medical community at large establish a medical ethics committees in hospitals which will be monitoring concerned parties on DNR decisions and develop clear guidelines for DNR decisions. In addition, it is essential to record the procedures for DNR decision, such procedure will make DNR decisions transparent and ethically sound.
Finally, this study points out the necessity to develop a program for DNR patients and families to cope with such difficult situations.