• Cristina Santonocito, Giuseppe Ristagno, Antonino Gullo, and Max Harry Weil.
• Department of Anaesthesia and Intensive Care, Medical School of Catania, Policlinico-Vittorio Emanuele, Via S.Sofia, 78 95123 Catania, Italy. cristina.santonocito@gmail.com
• J Crit Care. 2013 Feb 1;28(1):14-21.

AbstractResuscitation has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort, and consume resources. The do-not-resuscitate (DNR) order and advance directives are still a debated issue in critical care. This review will focus on several aspects, regarding withholding and/or withdrawing therapies and advance directives in different continents. It is widely known that there is a great diversity of cultural and religious beliefs in society, and therefore, some critical ethical and legal issues have still to be solved. To achieve a consensus, we believe in the priority of continuing education and training programs for health care professionals. It is our opinion that a serious reflection on ethical values and principles would be useful to understand the definition of medical professionalism to make it possible to undertake the best way to avoid futile and aggressive care. There is evidence of the lack of DNR order policy worldwide. Therefore, it appears clear that there is a need for standardization. To improve the attitude about the DNR order, it is necessary to achieve several goals such as: increased communication, consensus on law, increased trust among patients and health care systems, and improved standards and quality of care to respect the patient's will and the family's role.Copyright © 2013 Elsevier Inc. All rights reserved.

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