'No resuscitation' orders: perspectives, policies, problems and procedures

Area of Science:

• Medical Ethics
• Palliative Care
• Healthcare Administration

Background:

• Hospitals require clear policies for end-of-life care.
• Cardiopulmonary resuscitation (CPR) decisions are complex for terminally ill patients.

Purpose of the Study:

• To describe the ethical, administrative, and clinical factors for successful 'No CPR' order implementation.
• To guide physicians in negotiating 'No CPR' decisions with patients and families.

Main Methods:

• Review of a seven-year 'No CPR' policy at Chedoke-McMaster Hospitals.
• Analysis of physician roles, attitudes, and clinical strategies in decision-making.

Main Results:

• Physician attitudes toward death and professional responsibility significantly influence 'No CPR' order writing.
• Successful implementation relies on careful negotiation and clear communication.

Conclusions:

• Physician-patient-family communication is critical for 'No CPR' orders.
• Clinical strategies can facilitate these sensitive end-of-life discussions.