Unilateral Do-Not-Attempt-Resuscitation Orders: How Did We Get Here and Where Are We Going?

1. Utilizing a case-based approach, participants will self-report an understanding of the historical context of cardiopulmonary resuscitation, do-not-attempt-resuscitation (DNAR) orders, and unilateral do-not-attempt-resuscitation (UDNAR) orders. 2. Utilizing a case-based approach, participants will self report a knowledge of the ethical principles involved with UDNAR orders as well as concerns for unequal utilization of UDNAR orders for underserved populations. The principle of non-maleficence calls upon providers to not offer treatments we believe to be futile or non-beneficial. In recent years, this concept has led to the rise of so-called Unilateral Do-Not-Attempt-Resuscitation (UDNAR) orders. However, emerging evidence suggests that UDNAR orders may be disproportionately affecting underserved communities and may drive distrust between these communities and medical organizations. In serious illness communication, discussions around code status are common and typically occur in the context of end of life care. Traditionally, an individual's default code status has been understood to be "Full Code" and that cardiopulmonary resuscitation could only be withheld at the explicit request of a patient or their surrogate decision maker. However, providing full code measures for a patient dying of an irreversible process can cause a great deal of moral distress to clinicians. In the last 10-15 years the idea of a unilateral do-not-attempt resuscitation (UDNAR) order has gained increasing acceptance, recognizing that clinicians can identify when the aggressive treatment of a cardiopulmonary arrest provides little to no benefit to the terminally ill. More recently, however, controversies about when and how to invoke UNDAR orders have arisen. During the COVID pandemic, concerns were raised about inappropriate blanket DNAR orders for patient's severely ill with COVID, and recent studies have suggested that vulnerable populations may be inordinately subject to UDNAR orders in the hospital. In this case-based discussion, we will review the historical context of both cardiopulmonary resuscitation and do-not-attempt resuscitation (DNAR) orders; discuss the rise of UDNAR orders; outline the ethical argument for and against UDNAR orders; and explore recent work involving disparities in its application to patients at the end of life. Ethical / Legal Aspects of Care; Diversity, Equity, Inclusion, Belonging, Justice [ABSTRACT FROM AUTHOR]