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June 20, 2012

Challenges of Do-Not-Attempt-Resuscitation Orders

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: University of Warwick, Coventry, United Kingdom (Dr Perkins;; Worcestershire Acute Hospitals, Worcester, United Kingdom (Dr Pitcher); and North Bristol NHS Trust, Bristol, United Kingdom (Dr Soar).

JAMA. 2012;307(23):2487-2489. doi:10.1001/jama.2012.5601

To the Editor: In a Viewpoint, Dr Blinderman and colleagues highlighted the challenges faced when considering do-not-attempt-resuscitation decisions.1 Their recommendations have a number of similarities with the approach currently used in the United Kingdom. Guidance in the United Kingdom on this topic comes from a joint statement, “Decisions Relating to Cardiopulmonary Resuscitation”2 produced by the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing, and from the General Medical Council's publication, “Treatment and Care Towards the End of Life: Good Practice in Decision Making.”3 These guidelines identify 3 situations during which cardiopulmonary resuscitation (CPR) may be withheld: (1) when clinical judgment concludes that CPR will not be successful in restarting the patient's heart and breathing and restoring circulation; (2) when, following careful discussion with the patient (and/or those close to him/her), agreement is reached that benefits of CPR are outweighed by the burdens and risks; and (3) when a patient has an advanced decision (ie, living will) or makes an informed decision to refuse CPR.

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