Last updated on: 6/9/2008 2:40:00 PM PST
Do Do-Not-Resuscitate Orders Endanger Patients?
General Reference (not clearly pro or con)
The American Medical Association states in its Code of Ethics, "E-2.22 Do-Not-Resuscitate Orders," last updated on Aug. 22, 2005:
"Efforts should be made to resuscitate patients who suffer cardiac or respiratory arrest except when circumstances indicate that cardiopulmonary resuscitation (CPR) would be inappropriate or not in accord with the desires or best interests of the patient...
>Resuscitative efforts should be considered inappropriate by the attending physician only if they cannot be expected either to restore cardiac or respiratory function to the patient or to meet established ethical criteria...
DNR orders only preclude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient."
Aug. 22, 2005 - American Medical Association (AMA)
Hospice Patients Alliance President Ron Panzer wrote in his Jan. 30, 2006 article entitled "Dancing with Death" that appeared on the Hospice Patients Alliance website:
"Some people should be allowed to die when it truly is the end. But that 'logic' can be, and is, abused. People are labeled as 'DNR' inappropriately so that even minimal, ordinary treatments like providing food and water are denied them with the intent that they die sooner,... much sooner."
Jan. 30, 2006 - Hospice Patients Alliance (HPA)
Wesley Smith, JD, Consultant to the International Anti-Euthanasia Task Force, wrote in his Nov. 23, 1998 article, "Futile Care: Who Decides?" that appeared in Canada's National Post:
"Imagine your husband is in a hospital, struggling against a debilitating or life-threatening disease. If something goes wrong, you tell the doctor to do what he can because your husband wants to live. But the doctor says no, he does not believe that the quality of your husband's life is worth doing as you ask. Indeed, he is so adamant, he puts a Do Not Resuscitate (DNR) order on your husband's medical chart over your objections, meaning that if he suffers a cardiac arrest or some other life-threatening event, he plans to stand by idly and watch your husband die.
Frightening stuff. Unfortunately, it is also true."
Nov. 23, 1998 - Wesley J. Smith, JD
Mary Catherine Beach, MD, Assistant Professor at the Bloomberg School of Public Health at John Hopkins University and Sean Morrison, MD, Hermann Merkin Professor of Palliative Care at Mount Sinai School of Medicine, wrote in their Dec. 2002 article, "The Effect of Do-Not-Ressucitate Orders on Physician Decision-Making," that appeared in the Journal of the American Geriatrics Society:
"Patients with DNR orders were significantly less likely to be transferred to an intensive care unit, to be intubated, or to receive CPR. In some scenarios, the presence of a DNR order was associated with a decreased willingness to draw blood cultures...central line placement...or blood transfusion... The presence of a DNR order may affect physicians' willingness to order a variety of treatments not related to CPR."
Dec. 2002 - Mary Catherine Beach, MD
Sean Morrison, MD
David Muller, MD, Chair of Medical Education at Mount Sinai School of Medicine, wrote in his Sep.-Oct. 2005 article, "Do NOT Resuscitate," that appeared in Health Affairs:
"Preparing for death has its own ritual. It requires many family meetings, innumerable phone calls, lots of reassurance, and a great deal of reinforcement. It is critical that the family and patient have easy and immediate access to a nurse and doctor, as well as proper documentation at home on the patient's wishes about resuscitation, including--and this is essential--an out-of-hospital DNR form...
New York is one of the more than twenty states that has an out-of-hospital DNR law intended to ensure that emergency medical services (EMS) personnel do not resuscitate terminally ill people at home against their wishes...
The option to refuse cardiopulmonary resuscitation (CPR) exists because of resuscitation's dismal success rate: only 1-2 percent for out-of-hospital sudden cardiac death. And that's for a typically healthy businessman who collapses on the subway platform from a heart attack, not for someone dying of a terminal illness."
Sep.-Oct. 2005 - David Muller, MD
Mark Hilberman, MD, Anesthesiologist at Delano Regional Medical Center, wrote in his Dec. 1997 article entitled "Marginally Effective Medical Care: Ethical Analysis of Issues in Cardiopulmonary Resuscitation (CPR)," that appeared in the Journal of Medical Ethics:
"Cardiopulmonary resuscitation is a rough, some would say abusive, intervention. When life is snatched from death, this is inconsequential. However, cardiac arrest normally precedes death and providers are appropriately disturbed when they perform CPR on people afflicted by advanced illness, the debilities of old age, or dementia…
Since the decision not to perform CPR is irreversible, it is appropriate for there to be a bias toward its initiation. However, the extensive outcomes literature and ethical analysis justify a more limited application of CPR than do present DNR policies."
Dec. 1997 - Mark Hilberman, MD