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South Asian hospitals that lack DNAR orders deny patients holistic care

BMJ 2013; 347 doi: (Published 25 October 2013) Cite this as: BMJ 2013;347:f6300
  1. Sunil Bhandari, consultant nephrologist/honorary clinical professor, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, Hull Royal Infirmary Department of Renal Medicine, Kingston upon Hull HU3 2JZ, UK
  1. sunil.bhandari{at}

“Do not attempt resuscitation” orders are not a policy for euthanasia but recognise that futile treatment pursued in fear of the law is not based on need and is bad for patients, writes Sunil Bhandari

As a practising clinician I always imagined that “do not attempt resuscitation” (DNAR) was universal in medicine. Treatment with respect and dignity and shared decision making are of huge importance and are the pillars of great medical care. An important aspect of this goal of delivery of holistic care is the availability and appropriate use of DNAR.

Only recently, while in an Indian hospital visiting a family member, I was greatly surprised and somewhat dismayed that there was no DNAR policy. This had immense implications and unfortunately led to perhaps my worst experience of healthcare, which was driven to some extent by legal considerations. The problem, from my brief observations, seemed to be that the doctors were …

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