The do-not-resuscitate order. Ethical and legal imperative or medical decision?

Cardiopulmonary resuscitation (CPR), widely used in United States hospitals, results in long-term survival that averages about 15%. The patient has the ethical and legal right to reject CPR. Avoidance of CPR when death is anticipated, or when the patient does not wish resuscitation, requires the writing of a do-not-resuscitate order. Cardiopulmonary resuscitation has the risks of trauma, residual impairment if incompletely successful, and prolongation of dying. Like any other medical treatment, CPR should only be administered if it is expected to confer lasting benefit to the patient. If CPR does not offer even a modicum of lasting benefit, it is not medically appropriate to administer the treatment, and the physician may write a do-not-resuscitate order. The rationale for writing the order should be documented, and the patient and family should be informed of the treatment decision. Hospital regulations regarding the writing of DNR orders should reflect this approach. Experience to date indicates that there is minimal risk of malpractice or criminal action in relation to writing do-not-resuscitate orders.