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Unilateral do-not-attempt-resuscitation orders and ethics consultation: a case series
1Center for Bioethics, University of Pennsylvania, Philadelphia, USA.
Objective:
To describe the role of an ethics consultation service in unilaterally withholding cardiopulmonary resuscitation.
Design:
Retrospective case series of 31 ethics consultations regarding unilateral do-not-attempt-resuscitation orders between 1992 and 1996.
Setting:
A large, urban, academic medical center.
Measurements And Main Results:
Patient characteristics, physicians' rationale for withholding cardiopulmonary resuscitation, ethics consultants' recommendations, and patient outcomes were measured. The consultation service agreed with the medical team's intent to withhold cardiopulmonary resuscitation in 25 cases, but a unilateral do-not-attempt-resuscitation order was written in only seven of these. In 17 cases, the disagreement between the physician and the patient or surrogate over code status was resolved in a conference organized by the ethics service.
Conclusions:
The process of ethics consultation is useful in resolving disagreements over withholding cardiopulmonary resuscitation and other treatment and can frequently result in a consensus. Hospital policies that permit unilateral treatment limitation should be based on a model that is process-based and that encourages interdisciplinary participation in decision-making, such as that recently proposed by the Houston Task Force.