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Editorials |

End-of-Life Issues and the Do-Not-Resuscitate Order : Who Gives The Order and What Influences the Decision?

Ashok M. Karnik, MD, FCCP
Author and Funding Information

Affiliations: Stony Brook, NY
 ,  Dr. Karnik is Director, Pulmonary Care Unit, Nassau University Medical Center and Associate Professor of Clinical Medicine, State University of New York at Stony Brook.

Correspondence to: Ashok M. Karnik, MD, FCCP, Pulmonary Division, 10th Floor, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554



Chest. 2002;121(3):683-686. doi:10.1378/chest.121.3.683
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Life has been described as being, in many ways, a river: “God makes the rivers to flow. They tire not, nor do they cease from flowing. May the river of my life flow into the sea of love that is the Lord.”1 Or as being a journey: “Life is a journey from the cradle to the grave and beyond, and back to the cradle and on from life to life.”2 We do our best to help our patients overcome the obstacles during this journey that are posed by various illnesses and accidents. We make them better, and on they go with their travels. But as the patient nears the end of this journey, our focus changes. The intent at that time is not to cure, but to palliate; not to be a mere academician, but to be a sensitive and compassionate physician who respects the dignity of the patient and family, and their right to refuse treatment.3 It has been said that “a good physician knows the difference between postponing death and prolonging the act of dying.” A physician who has understood and assimilated this advice will be able to provide excellent care to his patients as they approach the end of life. Dr. Roger Bone, who has written poignantly about his own experience with the process of dying, in his guide entitled Reflections4 has said: “Dying can be a peaceful event or a great agony when it is inappropriately sustained by life support.”

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