Abstract
Although the living will in the end stage of life has become topical in recent years in Japan, the present condition of the term ‘do not attempt resuscitation’ (DNAR) is not sufficiently clear. In order to clarify the actual situation of DNAR, a survey was performed on subjects who died during the period from September 2004 to August 2005 in the Nagoya University Hospital. Deaths in the over 15 years old accounted for 404 cases, from which death caused by an abdominal disease was 181 cases in the general ward and 2 cases in the Emergency department. In these 181 cases, DNAR orders were given by a written document in one patient, orally in 8, family transferred from patients in 4, orally from the family in 114, and were unknown 2 cases. On the other hand, in 46 of 52 cases without the DNAR order it was believed that the judgment of DNAR was possible by the patients, and in 13 cases of those patients without any DNAR order, resuscitation was attempted at the time of cardiac arrest. This study shows that even in the terminal stage of chronic abdominal diseases, documentation of written DNAR orders was hardly seen. Even in the case of patients capable of judging for themselves, no DNAR order was suggested, and resuscitation was not performed even in these situations. The current state of the DNAR order of the end stage of life in Japan is also discussed using the results of the Ministry of Health, Labour and Welfare study group.
