To the Editor: In the 1970s, the American Heart Association determined that resuscitation is not an eligible therapy for all patients,1 which led to the do-not-resuscitate (DNR) decision as it is currently known. Individuals can make DNR decisions for themselves, or the decision can be made because resuscitation is considered futile, indicating that the disadvantages of resuscitation outweigh the small chance of success.2 Particularly in elderly adults, this chance is low, and these decisions are important.3 The chance of success is primarily estimated by considering patient-related factors that are known before the cardiac arrest.4 In practice, the presence of ventricular fibrillation (VF) or ventricular tachycardia (VT) is an important prognostic factor that significantly increases the chance of successful resuscitation.5 Because the presence of VF or VT is not known when a DNR decision is made, this factor is not taken into consideration. Should we not reconsider? At present, there are only two possibilities; the individual will or will not be resuscitated. This policy is unambiguous and easy in practice, but whether this policy with merely two options is sufficient and satisfactory is questionable, considering that some important prognostic factors are not taken into consideration. A modified DNR decision can remedy this situation and add nuance to current decision-making. This new type of DNR decision, a “VF-only decision,” indicates that the individual will not be resuscitated unless VF or VT is present during the arrest and therefore chance of success is good. In case of asystole, a situation with a small chance of success, resuscitation will not be performed.5 Although this new type of DNR decision has its advantages, it has drawbacks as well. In the case of cardiac arrest, no time should be lost by determining initial cardiac rhythm before starting resuscitation. In hospitals or medical institutions, the medical emergency team always performs a rhythm check on arrival. In individuals with a VF-only decision, resuscitation will be provided until the initial rhythm is determined. If there is no VF or VT, resuscitation will be ended. In out-of-hospital cardiac arrest, rhythm is determined using an automated external defibrillator (AED), and automatic instructions are given to bystanders who provide resuscitation. If the AED is not connected properly, it cannot be guaranteed that the rhythm determination is accurate. In addition, whether we should burden bystanders who provide resuscitation with making the decision to stop resuscitation is questionable. Therefore, we propose using this modified DNR decision only in healthcare institutions, including nursing homes and hospitals with emergency teams. One of the purposes of a DNR decision is to ensure a peaceful and worthy death, without futile, invasive treatment at the end of life. In this respect, a VF-only decision is not entirely satisfactory. In case of VF only, resuscitation would have to be provided only to be discontinued early in the case of asystole, and a peaceful, worthy death would be disturbed. The advantage of a VF-only decision lies in preventing prolonged resuscitation and providing needless care in intensive care units to individuals in asystole, who seldom survive until discharge, while at the same time retaining a chance of survival in the case of VF.5 In the case of a VF-only decision, the physician must properly inform the individual of the procedure and its disadvantages. After being informed and weighing the importance of a peaceful and worthy death and the chance of prolonging life, the individual will be able to make a decision. A VF-only decision is not suitable for everyone. Some people may find that death is no longer unwelcome. In which case, a DNR-decision is best, but elderly adults with multiple health problems are a relevant group. Those health problems are often not life threatening but decrease the chance of a successful resuscitation. They may not want to be resuscitated if there is only a small chance of survival, for the sake of their surviving relatives or themselves. Then a VF-only decision can be a good option. In conclusion, a new variant of the DNR decision is proposed. Currently, the decision is based on patient-related factors that are known before the arrest, even though the presence of VF or VT during arrest greatly influences the prognosis. By taking this factor into consideration, the burden:benefit ratio can be determined more accurately. This new variant of the DNR decision, a VF-only decision, is practicable in healthcare institutions and hospitals with medical emergency teams and is particularly relevant for elderly adults. By involving this important determinant, the VF-only decision brings nuance to current DNR-decision making. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Both authors contributed equally to writing this paper. Sponsor's Role: None.