According to research published in the Irish Medical Journal, the lack of professional guidelines surrounding DNAR orders has led to a deep confusion among physicians as to the correct procedures to take, with almost 50% of doctors saying they had "an unsatisfactory understanding" of DNAR issues.

The nationwide survey found that 67% of physicians felt that alert patients preferred not to discuss their own resuscitation, despite evidence that most patients prefer to do so.

Perhaps as a result of this preconception, 43% of doctors "almost never" discussed resuscitation preferences with their patients, and if a DNAR order is made without the patient's knowledge, the reasons for this decision are "almost never" documented by 32% of doctors.

"This situation will have to lead to legal action in the future, " said Dr Asim Sheikh, one of the authors of the study and a lecturer in legal medicine in University College Dublin. "I have no doubt that there will be major problems arising from this. What will happen is that a patient will die, and the family will request to see his medical files, and they will see the decision for DNAR has been made without asking them or their loved one. And they will go straight to the courts."

Sheikh said he had seen many medical files in which a DNAR order had been written down without any indication of which doctor made the decision. "There is often no signature or counter signature beside the decision, so no-one knows who has decided the patient should not be resuscitated, why that decision has been made and what . . . if any . . . consultation has taken place with the patient or the patient's family, " he told the Sunday Tribune. "I'm not saying that there is any sinister or malicious intent behind this, but it is vitally important that there is an indepth discussion with the patient on this matter, and that that discussion is properly documented."

However, Sheikh said that it was "understandable that this ignorance exists among doctors" because they had been given no professional guidelines to follow in this area. "The medical council, the HSE and the Department of Health have failed to give physicians any direction in relation to DNAR issues, " he said.