TABLE 1

Key Considerations Regarding Pediatric Unilateral DNAR Orders

Physicians do not, and should not, have an ethical obligation to provide treatment that offers no benefit to the patient. Rather, the obligation is to compassionately discuss the situation, reasonable options, and what will be done
Asking parents to approve a DNAR order when death in the near future is inevitable may place an unnecessary and potentially significant burden on them
Performing CPR that offers virtually no chance of restoring vital signs may benefit the family in some circumstances, such as providing a desired ritual or giving them the feeling that “everything was tried.” It is controversial whether this justifies the potential harms to the patient, such as pain and indignity
A unilateral DNAR order by the physician based on predicted disability risks inappropriately placing the values of the physician regarding quality of life over those of the patient or parents. Thus, unilateral decisions regarding DNAR status should generally be limited to cases of unavoidable imminent death, and perhaps the most extreme cases of poor quality of life, after confirmation of the prognosis and advisability of DNAR with colleagues
The law regarding unilateral DNAR orders varies among states, and physicians should be familiar with the law where they practice