Reviving the conversation around CPR/DNR.
This paper examines the historical rise of both cardiopulmonary resuscitation (CPR) and the do-not-resuscitate (DNR) order and the wisdom of their continuing status in U.S. hospital practice and policy. The practice of universal presumed consent to CPR and the resulting DNR policy are the products of a particular time and were responses to particular problems. In order to keep the excesses of technology in check, the DNR policies emerged as a response to the in-hospital universal presumed consent to CPR. We live with this historical concretion, which seems to perpetuate a false culture that the patient's wishes must be followed. The authors are critical of the current U.S. climate, where CPR and DNR are viewed as two among a panoply of patient choices, and point to UK practice as an alternative. They conclude that physicians in the United States should radically rethink approaches to CPR and DNR.
Bishop
Jeffrey P
JP
Vanderbilt University Medical Center, Center for Biomedical Ethics and Society, 2525 West End Ave, Suite 400, Nashville, TN 37203, USA. jeffrey.bishop@vanderbilt.edu
Brothers
Kyle B
KB
Perry
Joshua E
JE
Ahmad
Ayesha
A
D022561:Advanced Cardiac Life Support / Q000941:ethics / Q000639:trends; D016887:Cardiopulmonary Resuscitation / Q000941:ethics / Q000266:history / Q000592:standards / Q000639:trends; D002755:Choice Behavior / Q000941:ethics; D003142:Communication; D004632:Emergency Medical Services / Q000941:ethics / Q000592:standards / Q000639:trends; D004992:Ethics, Medical; D006291:Health Policy / Q000266:history / Q000331:legislation & jurisprudence / Q000639:trends; D049673:History, 20th Century; D049674:History, 21st Century; D006761:Hospitals; D006801:Humans; D018447:Medical Futility; D009518:New York; D016134:Organizational Policy; D026706:Paternalism; D010358:Patient Participation; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000639:trends; D019724:Presumed Consent; D011379:Prognosis; D011639:Public Opinion; D016414:Resuscitation Orders / Q000941:ethics; D016896:Treatment Outcome; D006113:United Kingdom; D014481:United States