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Deciding Whether to Resuscitate

Deciding Whether to Resuscitate Abstract Cardiopulmonary resuscitation (CPR) may be inappropriate for patients with multiple chronic illnesses for whom cardiopulmonary arrest is the inevitable result of a worsening clinical course. Cardiopulmonary resuscitation usually is unsuccessful in such patients; moreover, many patients with chronic or terminal illness do not want the natural course of dying interrupted by CPR. Do not resuscitate (DNR) orders are orders not to initiate CPR. The principles justifying and the procedures for making DNR orders have been discussed. Guidelines recommend that a DNR order may be written if further medical treatment is futile and/or if the competent patient does not want CPR.1-5 Applying general guidelines, however, may be difficult, as the following cases illustrate. REPORT OF CASES Case 1. —A 30-year-old woman had had Gardner's syndrome and carcinoma of the colon with lung, skin, bone, and epidural metastases. Despite a laminectomy and radiation therapy, she was paraplegic.She was admitted to References 1. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA 1980;244:453-509.Crossref 2. Optimal care for hopelessly ill patients. Clinical Care Committee of the Massachusetts General Hospital. N Engl J Med 1976;295:362-364.Crossref 3. Rabkin MT, Gillerman G, Rice NR: Orders not to resuscitate. N Engl J Med 1976;295:365-367.Crossref 4. Miles SH, Cranford R, Schultz AL: The do not resuscitate order in a teaching hospital. Ann Intern Med 1982;96:660-664.Crossref 5. Jonsen AR, Siegler M, Winslade WJ: Clinical Ethics . New York, Macmillan Publishing Co Inc, 1982. 6. Lo B, Jonsen AR: Clinical decisions to limit treatment. Ann Intern Med 1980;93:764-768.Crossref 7. Spencer SS: 'Code' or 'no code': A nonlegal opinion. N Engl J Med 1979;300:138-139.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Deciding Whether to Resuscitate

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References (8)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350080079017
Publisher site
See Article on Publisher Site

Abstract

Abstract Cardiopulmonary resuscitation (CPR) may be inappropriate for patients with multiple chronic illnesses for whom cardiopulmonary arrest is the inevitable result of a worsening clinical course. Cardiopulmonary resuscitation usually is unsuccessful in such patients; moreover, many patients with chronic or terminal illness do not want the natural course of dying interrupted by CPR. Do not resuscitate (DNR) orders are orders not to initiate CPR. The principles justifying and the procedures for making DNR orders have been discussed. Guidelines recommend that a DNR order may be written if further medical treatment is futile and/or if the competent patient does not want CPR.1-5 Applying general guidelines, however, may be difficult, as the following cases illustrate. REPORT OF CASES Case 1. —A 30-year-old woman had had Gardner's syndrome and carcinoma of the colon with lung, skin, bone, and epidural metastases. Despite a laminectomy and radiation therapy, she was paraplegic.She was admitted to References 1. Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC) . JAMA 1980;244:453-509.Crossref 2. Optimal care for hopelessly ill patients. Clinical Care Committee of the Massachusetts General Hospital. N Engl J Med 1976;295:362-364.Crossref 3. Rabkin MT, Gillerman G, Rice NR: Orders not to resuscitate. N Engl J Med 1976;295:365-367.Crossref 4. Miles SH, Cranford R, Schultz AL: The do not resuscitate order in a teaching hospital. Ann Intern Med 1982;96:660-664.Crossref 5. Jonsen AR, Siegler M, Winslade WJ: Clinical Ethics . New York, Macmillan Publishing Co Inc, 1982. 6. Lo B, Jonsen AR: Clinical decisions to limit treatment. Ann Intern Med 1980;93:764-768.Crossref 7. Spencer SS: 'Code' or 'no code': A nonlegal opinion. N Engl J Med 1979;300:138-139.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Aug 1, 1983

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