title: Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial.
abstract: OBJECTIVE
  This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed.
  
  
  METHODS
  This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 at a large academic hospital with a not offering CPR policy.
  
  
  RESULTS
  There were 134 cases of disagreement over whether to provide CPR. In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. There was no significant relationship between age, race, or functional status and the recommendation not to offer CPR. Patients who were not offered CPR were more likely to be critically ill (61.2% vs 18.2%, P < .001). The 90-day mortality rate among patients who were not offered CPR was 90.2%.
  
  
  CONCLUSIONS
  There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.
authors.affiliation: Patient Care Services, Institute for Patient Care, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: acourtwright@partners.org.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Courtwright
authors.affiliation: Patient Care Services, Ellison 4 Surgical Intensive Care Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Brackett
authors.affiliation: Department of Sociology, Brandeis University, Waltham, MA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Cadge
authors.affiliation: Division of Palliative Care, Massachusetts General Hospital, Boston, MA; Departments of Medicine and of Global Health & Social Medicine, Harvard Medical School, Boston, MA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Krakauer
authors.affiliation: Patient Care Services, Institute for Patient Care, Massachusetts General Hospital, Boston, MA; Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D026688:Bioethical Issues; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000941:ethics* / Q000401:mortality; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D034462:Dissent and Disputes; D028741:Ethics Committees, Clinical / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D044469:Racial Groups / Q000208:ethnology / Q000706:statistics & numerical data; D016414:Resuscitation Orders / Q000941:ethics*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D028761:Withholding Treatment / Q000941:ethics / Q000706:statistics & numerical data
keywords: Cardiopulmonary resuscitation; Do not resuscitate; End of life; Ethics consultation; Medical ethics; Medical futility