A national study has found a high level of dissatisfaction, confusion and varying practices among Irish consultant physicians regarding the making of decisions on whether to resuscitate patients in certain circumstances.
More than 170 consultants across 38 hospitals took part in the study and while 58 per cent of them indicated they "nearly always" discussed a patient's resuscitation status with the patient's relatives, 37 per cent said they did this only "sometimes" and 3 per cent indicated they "almost never" did so.
The study's authors have called for the formation of a national policy on resuscitation decision-making, which they say exists in many countries.
They also say it is of concern that 10 of the doctors surveyed were not making resuscitation decisions at all, with some of them leaving it to junior doctors.
Doctors make decisions not to resuscitate patients in different circumstances.
The most common reasons cited by doctors in this study for making "do not attempt resuscitation" or DNAR orders included, in order of frequency: end-stage disease (34 per cent); futility (21 per cent); cancer-related diagnosis (16 per cent); elderly with co-morbidities (13 per cent); and expected poor quality of life post-resuscitation (4 per cent).
When asked if they thought any patient group was more likely to be the subject of a DNAR order, the most common groups mentioned by the consultants questioned in this study were "terminally ill" people, "elderly" people or the "terminally ill and elderly".
Some 59 per cent of physicians said they believed both they and the next of kin were jointly responsible for deciding resuscitation status of an incapacitated patient with no advance directive as to what should happen to him/her, while 35 per cent felt they were solely responsible in such circumstances.
Only one-fifth of the doctors said they were aware of a formal resuscitation policy in their hospital.
The doctors were surveyed in 2003 but the findings have only now been published in the latest edition of the Irish Medical Journal.
Its authors, who include doctors from Loughlinstown Hospital, Dublin and a member of staff of the Division of Legal Medicine at University College Dublin, warn that the legal/ethical status of DNAR orders in the Republic has not been clarified.
They conclude: "The medico-legal and medico-ethical status of DNAR orders and advance medical directives needs to be clarified nationally.
"The Irish Medical Council ethical guidelines do not address resuscitation decision-making in detail," they said.
"We recommend the formation of a national policy for resuscitation decision-making, as exists in many countries, to facilitate more widespread local policy formation."
Asked if it was considering a national policy, the Department of Health said: "The Medical Council ethical guidelines do refer to the issue of resuscitation decisions.
"The issue of consent, including the role of next of kin, is the subject of a current review by the Law Reform Commission - the outcome of which will provide a basis for further policy in this area," the department said.
The Medical Council's ethical guidelines say it is desirable that a doctor discusses management of a seriously ill patient who is unable to communicate with the next of kin or legal guardians prior to reaching a decision on "the use or non-use of treatments which will not contribute to recovery from the primary illness".
It adds that in the event of a dispute between the doctor and relatives, a second opinion should be sought from a suitably qualified and independent medical practitioner.
The guidelines also say that where death is imminent, "a doctor is not obliged to initiate or maintain a treatment which is futile or disproportionately burdensome".