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Article
September 12, 1990

Family Consent to Orders Not to ResuscitateReconsidering Hospital Policy

Author Affiliations

From the Divisions of Medical Humanities (Dr Hackler) and Pulmonary and Critical Care Medicine (Dr Hiller), University of Arkansas for Medical Sciences, and John L. McClellan Memorial Veterans Hospital (Dr Hiller), Little Rock, Arkansas.

From the Divisions of Medical Humanities (Dr Hackler) and Pulmonary and Critical Care Medicine (Dr Hiller), University of Arkansas for Medical Sciences, and John L. McClellan Memorial Veterans Hospital (Dr Hiller), Little Rock, Arkansas.

JAMA. 1990;264(10):1281-1283. doi:10.1001/jama.1990.03450100071028
Abstract

Hospital policies typically require that cardiopulmonary resuscitation be attempted unless a do-not-resuscitate order has been written, and they further require that family permission for the order be obtained. This sometimes forces physicians to perform procedures that are useless or that add to the patient's suffering without corresponding benefit. Policies should be changed to allow physicians to write a do-not-resuscitate order over family objections when (1) the patient lacks decision-making capacity, (2) the burdens of treatment clearly outweigh the benefits, (3) the surrogate does not give an appropriate reason in terms of patient values, preferences, or best interests, and (4) the physician has made serious efforts to communicate with the family and to mediate the disagreement. Furthermore, when resuscitation would clearly provide no medical benefit to the patient, policy should not require that it be discussed with either the patient or the family.

(JAMA. 1990;264:1281-1283)

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