Physicians' Perceptions of Patient Autonomy in Do Not Resuscitate Decision-Making: A Comparison Between the US and UK

In both the United States, and increasingly in the United Kingdom, consumerization and deprofessionalization have resulted in increasing demands for patient autonomy in health care decisions (Haug, 1973). Loss of physician authority and concerns over paternalistic practices shifted decision-making power towards patients at the expense of physician control over clinical decisions (Truog, 2012).

Using the example of the Do Not Resuscitate (DNR) order at the end of life, I discuss how decisions made between physicians and patients reflect changing power dynamics, and how unlimited patient choice might threaten the physician’s ability to act in the best interest of their patient. In the US, DNR decisions are largely determined by patient choice whereas in the UK, physicians are permitted to make decisions unilaterally based on what they believe is in the patient’s best interest. Through semi-structured interviews in the US and UK, I explore how prioritization of choice and patient autonomy over clinical judgment result in conflicts in DNR decision making and moral distress in American doctors in ways that do not occur in Britain.

Less experienced physicians in the US feel especially compelled to offer unlimited choice, as compared to more experienced physicians who feel more comfortable giving recommendations based on clinical judgment. Despite this, most American physicians acknowledge that patients often do not have sufficient information or the tools necessary to make informed decisions. Junior doctors tend to perceive recommendations as a violation of patient autonomy and are less willing to take on the burden of responsibility for clinical decision making due to lack of experience and confidence. These prioritizations of unrestricted choice forces physicians to perform futile therapies that they believe are harmful to the patient and ethically unacceptable.