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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "239" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen Carballada-Rico, Eugenia Ameneiros-Lago" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "Carballada-Rico" "email" => array:1 [ 0 => "carmen.carballada.rico@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eugenia" "apellidos" => "Ameneiros-Lago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Hospitalización a Domicilio, Comité de Ética Asistencial de la Gerencia Integrada de Ferrol, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Comité de Ética Asistencial de la Gerencia Integrada de Ferrol, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las órdenes de no reanimar: ¿siempre consensuadas?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the excellent article recently published in the journal by Ruíz-García et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> which analyses the history and current situation of do-not-resuscitate (DNR) orders. The article defines a DNR order as “the order which, explicitly written, signed and dated by a physician in the medical history of the patient after consensus with him, or with his/her representative or relative if incapacitated, only prohibits the use of resuscitative measures in case of cardiopulmonary arrest (CPA)”. Although, on the definition of the DNR order, the need to reach a consensus with the patient or representative or family, in case of patient incapacity, is included; in our opinion, this is not always necessary.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In most cases, DNR orders correspond to decisions to withhold life support (WLS).<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a> This means that professionals who care for that patient have made a careful assessment of the situation and after it have concluded that cardiopulmonary resuscitation is a disproportionate measure and thus establish an DNR order. WLS decisions are based on professional opinions and are part of good clinical practice. In the process of informing the family or representative about the said decisions, the information quality should be ensured. This should not be confused with a request for consent in order to reach a consensus. This confusion could lead to therapeutic obstinacy.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> In our opinion, also in this context, it may not be advisable to provide this information to the patient, as it may be detrimental for him to receive more information than what is necessary.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We do consider important to highlight the need for consensus among professionals caring for the patient at the time of establishing a DNR order, as these should not be the result of the opinion of a single professional.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A different question would be those intermediate situations, less frequent in our view, where the disproportion of resuscitation is unclear. In this case, consensus is necessary, since the opinion of the patient or his representative or family member must be considered for proper decision making.</p><p id="par0025" class="elsevierStylePara elsevierViewall">All these processes require the careful management of doctor–patient communication. In this sense, we agree with the authors on the need to promote doctor–patient conversations about the end-of-life care they want.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carballada-Rico C, Ameneiros-Lago E. Las órdenes de no reanimar: ¿siempre consensuadas? Med Clin (Barc). 2017;148:239.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las órdenes de no reanimar. Historia y situación actual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ruiz-García" 1 => "I. Canal-Fontcuberta" 2 => "M. Martínez-Sellés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin" "fecha" => "2016" "volumen" => "147" "paginaInicial" => "316" "paginaFinal" => "320" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ética y muerte digna: propuesta de consenso sobre un uso correcto de las palabras" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Simón-Lordá" 1 => "I. Barrio-Cantalejo" 2 => "F.J. Alarcos-Martínez" 3 => "J. Barbero-Gutiérrez" 4 => "A. Couceiro" 5 => "P. Hernando-Robles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1134-282X(08)75035-8" "Revista" => array:6 [ "tituloSerie" => "Rev Calid Asist" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "271" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23040274" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adecuación de las intervenciones clínicas en pacientes con enfermedad avanzada y compleja. Propuesta de algoritmo para la toma de decisiones" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Ameneiros-Lago" 1 => "C. Carballada-Rico" 2 => "J.A. Garrido-Sanjuán" 3 => "A. García-Martínez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cali.2014.12.010" "Revista" => array:6 [ "tituloSerie" => "Rev Calid Asist" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "38" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25666087" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Los cuidados al final de la vida. Documento de recomendaciones. Consellería de Sanidad. Servicio Gallego de Salud. Santiago de Compostela 2012 [accessed 7 Nov 2016] Available in: <a href="http://www.sergas.es/Docs/bioetica/Cuidados%20CAST-240912-link">http://www.sergas.es/Docs/bioetica/Cuidados%20CAST-240912-link</a>" ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014800000005/v1_201704020027/S2387020617301717/v1_201704020027/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014800000005/v1_201704020027/S2387020617301717/v1_201704020027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617301717?idApp=UINPBA00004N" ]
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Vol. 148. Issue 5.
Pages 239 (March 2017)
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Vol. 148. Issue 5.
Pages 239 (March 2017)
Letter to the Editor
Do-notresuscitate orders: Always with consensus?
Las órdenes de no reanimar: ¿siempre consensuadas?
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a Unidad de Hospitalización a Domicilio, Comité de Ética Asistencial de la Gerencia Integrada de Ferrol, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
b Servicio de Medicina Interna, Comité de Ética Asistencial de la Gerencia Integrada de Ferrol, Complejo Hospitalario Universitario de Ferrol, Ferrol, La Coruña, Spain
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Med Clin. 2017;148:24010.1016/j.medcle.2016.12.054
Juan Ruiz-García, Irene Canal-Fontcuberta, Manuel Martínez-Sellés
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