We investigated emergency patients’ end-of-life decisions in to assess prevalence of decisions not to receive resuscitation (“do not attempt resuscitation”, or DNAR). We also examined potential medical and economic consequences and estimated the relative contributions of patient characteristics (such as age) and physicians to such decisions. The study was a single-centre retrospective observation at the University Hospital of Basel, including emergency patients with subsequent hospitalization between 2012 and 2016.

We found that decision to NOT receive resuscitation are common in emergency patients (ca. 23%) and that these decisions are associated with age (OR = 4.0, 95% CI = 3.6–4.3) and non-trauma presentation (OR = 2.3, 95% CI = 1.9–2.9). In other words, older and chronic disease patients are more likely to forego resuscitation. Mortality was significantly higher (OR = 5.4, CI = 4.0–7.3) and use of resources significantly lower (OR = 0.7, CI = 0.6–0.8) in patients with DNAR, suggesting that these decisions have important personal and economic consequences. One thing that was really interesting and, potentially, important, is that we found evidence for physician effects! This implies that there were significant effects of physician on whether someone decided to in principle forego resuscitation. Unfortunately, we cannot tell what about the physician or his/her communication led to such an effect but this finding raises questions about the autonomy of patients in their end-of-life decisions. It could be important to investigate further how these decisions are being made and how physicians impact these outcomes.

Siegrist, V., Eken, C., Nickel, C. H., Mata, R., Hertwig, R., & Bingisser, R. (2018). End-of-life decisions in emergency patients: Prevalence, outcome, and physician effect. QJM: An International Journal of Medicine. https://doi.org/10.1093/qjmed/hcy112