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December 27, 1985

Doctor's Orders

Author Affiliations

Joseph and Rose Kennedy Institute of Ethics Georgetown University Washington, DC

JAMA. 1985;254(24):3468. doi:10.1001/jama.1985.03360240080041

The "do not resuscitate" (DNR) order has become an important phenomenon in the evolution of more responsive and humane care of critically and terminally ill patients. Guidelines for decisions pertaining to resuscitation have been developed and are the source of much research,1,2 therapeutic discussion,3,4 and policy debate.5

Underlying these discussions about decisions to forego resuscitation and a whole range of other decisions in the medical sphere is a broader conceptual problem: the problem of the metaphor of orders.

What is going on when an institution as important as health care chooses the image of order giver? At the same time, society and the health professions alike are moving toward a consensual or covenantal model in which the patient makes choices with the support of significant others including family, friends, clergy, and health care professionals. Is the language of order giver compatible with these new, exciting developments that signal