Do Not Resuscitate (DNR) Policies and Practices in Turkey and Worldwide: A Review from a Nursing Perspective

Yıl 2025, Cilt: 12 Sayı: 3, 159 - 170, 26.09.2025

Simay Ezgi Budak Aşıklı

Öz

End-of-life decisions involve complex processes with ethical, legal, and cultural dimensions for healthcare professionals, patients, and families. Among these decisions, the "Do Not Resuscitate" (DNR) order indicates that no resuscitation should be performed in the event of cardiac or respiratory arrest. DNR practices are subject to varying legal regulations worldwide; in some countries, they are legally recognized, while in others, their legal framework is either unclear or prohibited. In Turkey, however, there is no explicit legal regulation regarding DNR. Nurses play a significant role in relation to DNR orders, assisting patients, families, surrogate decision-makers, and healthcare team members in the decision-making process, advocating for patients, contributing to the seamless implementation of the process, and participating in education, research, and policy development activities. However, legal uncertainties, ethical dilemmas, and limitations regarding professional autonomy influence nurses' attitudes toward this process. For DNR decisions to be approached with a patient-centered perspective, it is essential for nurses to be more actively involved in decision-making processes. Additionally, clarifying related legal regulations and ethical guidelines, defining nurses' duties and responsibilities, including them in decision-making processes, and developing comprehensive education programs on DNR for nurses in Turkey are recommended. This review addresses the legal regulations related to DNR orders both worldwide and in Turkey, and further evaluates the current situation by examining nurses' roles and responsibilities in DNR orders, as well as their perceptions and attitudes toward DNR.

Anahtar Kelimeler

DNR , nursing , end of life care , ethics , policy

Türkiye ve Dünya Genelinde Yeniden Canlandırmama (DNR) Politikaları ve Uygulamaları: Hemşirelik Perspektifinden Bir Derleme

Öz

Yaşamın son dönemine ilişkin kararlar, etik, hukuki ve kültürel boyutlarıyla sağlık profesyonelleri, hastalar ve aileler için karmaşık süreçler içermektedir. Bu kararlar arasında yer alan “Do Not Resuscitate (DNR – Yeniden Canlandırmama)” talimatı, hastanın kalp veya solunum durması halinde resüsitasyon uygulanmamasını ifade eder. DNR uygulamaları dünya genelinde farklı yasal düzenlemelere tabidir; bazı ülkelerde yasal olarak tanınırken, bazılarında hukuki çerçevesi belirsizdir ya da yasaklanmıştır. Türkiye'de ise DNR'ye ilişkin açık bir yasal düzenleme bulunmamaktadır. Hemşireler DNR talimatları konusunda; hastalara, ailelere, vekil karar vericilere ve sağlık ekibi üyelerine karar verme süreçlerinde yardımcı olma, hasta savunuculuğu yapma, sürecin sorunsuz bir şekilde uygulanmasına katkı sağlama, konuyla ilgili eğitim, araştırma ve politika oluşturma faaliyetlerine katılma gibi pek çok rol üstlenmektedir. Buna karşın, yasal belirsizlikler, etik ikilemler ve mesleki özerklik konusundaki sınırlamalar, hemşirelerin bu sürece ilişkin tutumlarını etkilemektedir. DNR kararlarının hasta merkezli bir yaklaşımla ele alınabilmesi için hemşirelerin karar alma süreçlerine daha aktif katılımı gereklidir. Ek olarak, Türkiye’de konuyla ilişkili yasal düzenlemelerin ve etik kılavuzların netleştirilmesi, hemşirelerin görev ve sorumluluklarının belirlenmesi, karar süreçlerine dahil edilmesi ve DNR konusunda hemşirelere yönelik kapsamlı eğitim programlarının geliştirilmesi önerilmektedir. Bu derleme, dünyada ve Türkiye’de DNR talimatlarına ilişkin yasal düzenlemeleri ele almakta; bunun yanı sıra hemşirelerin DNR talimatlarındaki rol ve sorumluluklarını ve DNR konusuna ilişkin algı ve tutumlarını inceleyerek mevcut durumu değerlendirmektedir.

Anahtar Kelimeler

DNR , hemşirelik , yaşam sonu bakım , etik , politika

Kaynakça

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