title: Two decades of British newspaper coverage regarding do not attempt cardiopulmonary resuscitation decisions: Lessons for clinicians.
abstract: OBJECTIVE
  To review UK newspaper reports relating to Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in order to identify common themes and encourage dialogue.
  
  
  METHODS
  An online media database (LexisNexis(®)) was searched for UK Newspaper articles between 1993 and 2013 that referenced DNACPR decisions. Legal cases, concerning resuscitation decisions, were identified using two case law databases (Lexis Law(®) and Westlaw(®)), and referenced back to newspaper publications. All articles were fully reviewed.
  
  
  RESULTS
  Three hundred and thirty one articles were identified, resulting from 77 identifiable incidents. The periods 2000-01 and 2011-13 encompassed the majority of articles. There were 16 high-profile legal cases, nine of which resulted in newspaper articles. Approximately 35 percent of newspaper reports referred to DNACPR decisions apparently made without adequate patient and/or family consultation. "Ageism" was referred to in 9 percent of articles (mostly printed 2000-02); and "discrimination against the disabled" in 8 percent (mostly from 2010-12). Only five newspaper articles (2 percent) discussed patients receiving CPR against their wishes. Eighteen newspaper reports (5 percent) associated DNACPR decisions with active euthanasia.
  
  
  CONCLUSIONS
  Regarding DNACPR decision-making, the predominant theme was perceived lack of patient involvement, and, more recently, lack of surrogate involvement. Negative language was common, especially when decisions were presumed unilateral. Increased dialogue, and shared decision-making, is recommended.
authors.affiliation: Intensive Care and Anaesthesia, Nottingham University Hospital, Nottingham NG5 1PB, UK. Electronic address: martin.beed@nottingham.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Beed
authors.affiliation: Intensive Care and Anaesthesia, Nottingham University Hospital, Nottingham NG5 1PB, UK. Electronic address: thearina.debeer@nuh.nhs.uk.
authors.forename: Thearina
authors.initials: T
authors.lastname: de Beer
authors.affiliation: Critical Care Medicine, Dosseter Ethics Centre, Anaesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada, T6G2B7. Electronic address: peter.brindley@albertahealthservices.ca.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Brindley
mesh_terms: D016887:Cardiopulmonary Resuscitation; D000066491:Clinical Decision-Making; D006801:Humans; D008402:Mass Media; D016414:Resuscitation Orders; D006113:United Kingdom
keywords: DNR; Do Not Attempt Cardiopulmonary Resuscitation (DNACPR); Resuscitation orders