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June 1985

'Do Not Resuscitate' Decisions: A Prospective Study at Three Teaching Hospitals

Author Affiliations

From the Division of General Internal Medicine (Drs Lo, Strull, and Thomas and Mr Saika) and the Institute for Health Policy Studies (Dr Lo and Mr Showstack), University of California, San Francisco.

Arch Intern Med. 1985;145(6):1115-1117. doi:10.1001/archinte.1985.00360060183028

Guidelines for "do not resuscitate" (DNR) orders recommend joint decisions by physicians and competent patients or families of incompetent patients.1-4 However, some physicians fear that discussing DNR orders with patients may be thoughtless or cruel and advocate that the physician alone make these decisions.5 It is not known how actual practice conforms to the recommended guidelines or whether these guidelines are feasible. Little is known about how often patients and families participate in decisions, how often agreement is possible, and what problems occur when physicians share decision making with patients or family.

To address these issues, our study asked several questions: First, how often are DNR orders written on a general medical inpatient service? Second, what reasons are given for DNR orders? Third, how do patients and families participate in DNR decisions? Finally, what problems occur in the decision-making process?

METHODS  We studied prospectively 3,282 patients admitted to

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