DNR decisions within oncology and hematology care. Clinical and ethical perspectives

Within oncology and hematology care, patients in a terminal phase of cancer sometimes have such a poor prognosis that Coronary Pulmonary Rescue (CPR) is not considered justifiable in case of cardiac arrest.

This can lead to a DNR order to be issued by the responsible physician, implying that in case of a cardiac arrest neither basic nor advanced CPR is to be performed. DNR situations can lead to severe ethical dilemmas and moral distress among the staff.


The aim of this project is to investigate attitudes to and perceptions of ‘Do Not Resuscitate’ (DNR) orders among staff in oncology and hematology care. The need for a certain ethical competence for these decisions will be investigated. Further the experiences of education in DNR and understanding of DNR orders among students in nursing and medical school will be investigated.

Research design

The project consists of four studies:

  1. In an interview study, using qualitative methodology, oncology and hematology nurses will be asked about their experiences and perceptions of DNR decisions.
  2. In a similar qualitative study, physicians working within oncology and hematology will be interviewed on their experiences and perceptions of DNR decisions.
  3. Based on the empirical results in study 1 and 2 an analysis of what ethical competence staff needs in order to make sound decisions concerning DNR within oncology and hematology care will be performed.
  4. In a quantitative study, using a web based survey, nursing and medical students will be investigated concerning their understanding of DNR and their education on this concept.

about the project

This PhD project is funded by The Swedish Cancer Society (Cancerfonden) and runs from 2010-2018.



  • Anna T. Höglund, Associate Professor of Ethics
  • Mariann Hedström, Senior lecturer, Department of Public Health and Caring Science


  • Gunnar Birgegård, Professor, Department of Medical Sciences


Pettersson M, Hedström M and Höglund AT, Striving for good nursing care: Nurses' experiences of do not resuscitate orders within oncology and hematology care, Nursing Ethics published online 9 June 2014, DOI: 10.1177/0969733014533238

Vårdetik och omvårdnadsetik

Relalationen mellan sjuksköterska och patient är inte jämlik. Hur ser man till att mötet ändå blir respektfullt? Vilka etiska dilemmans uppstår i sjuksköterskors vardag? Och hur kan man lösa dem?

Mycket av vår kliniskt inriktade forskning handlar om vårdetik och omvårdens etik. Vi har sammanställt våra publikationer på området (med abstracts) i en rapport. Rapporten är på engelska.

Ladda ner rapporten on "Nursing ethics"