Attitudes and practices about do-not-resuscitate orders in Turkey

Objective

To determine attitudes and practices of the Turkish anesthesiologists about Do-Not-Resuscitate (DNR) orders and to recommend educational programs to improve the understanding of the role of the anesthesiologist in end-of-life care.

Design

An anonymous questionnaire consisting of 18 questions was mailed to 439 members of the Turkish Society of Anesthesiology and Reanimation, and 369 returned responses were evaluated.

Results

Three hundred and sixty-nine questionnaires were returned (84% response). Of the respondents, 56% were male 44% female. Over 90% of the respondents indicated that they were Muslim. One-half of respondents work in hospitals with more than 800 beds; 49.1% of respondents had an intensive care unit facility of seven to 12 beds. We found that 66% of respondents had initiated written or oral (94.2%) DNR orders most frequently after discussing with colleagues (82.7%). Clinical scenarios provided specific examples of the decision-making challenges facing the anesthesiologist. In these examples, support was most often continued even when the patient had no chance of meaningful recovery no matter whether the patient had family or not. In this situation, male physicians and physicians having intensive care unit experiences of less than 5 years showed significantly high rates of maintaining full life support (62.1% and 61.0%, respectively), even when the family desired that support be withdrawn. Experience also influenced decision-making independence. Physicians with less experience indicated that decisions should be made by concensus more often than did those with over 5 years of experience in intensive care medicine. Younger physicians also indicated a greater concern about the potential to be punished for decisions to withhold or withdraw care than did those with more years of experience.

Conclusions

This study defined the attitudes of Turkish anesthesi-ologists about end-of-life care and DNR orders. While a number of similarities were found between Turkish physicians and those from other countries, some specific differences could be identified, particularly related to concensus decision making and to sharing information with other providers and the value of ethics committees in the decision-making process, even when the family and physicians concur on the plans for further care.