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Conditional Permission to Not Resuscitate: A Middle Ground for Resuscitation

Richard B Stuart1, Stephen Thielke2

  • 1Swedish Edmonds Hospital, Samish Island Volunteer Fire Department, Bow, WA; Department of Psychiatry, University of Washington, Seattle, WA.

Journal of the American Medical Directors Association
|March 4, 2019
PubMed

Insights

Cardiopulmonary resuscitation (CPR) decisions involve complex ethics. A new DNAR-X option allows patients to customize CPR preferences, enhancing autonomy in medical decision-making.

Area of Science:

  • Medical Ethics
  • Emergency Medicine
  • Patient Autonomy

Background:

  • Decisions regarding cardiopulmonary resuscitation (CPR) carry significant ethical weight, often made rapidly with incomplete information.
  • CPR outcomes are variable, with potential for success or serious iatrogenic consequences, necessitating informed patient consent.
  • Current protocols offer limited choices, typically only allowing patients to accept or refuse CPR.

Purpose of the Study:

  • To explore the ethical implications of CPR decisions.
  • To propose an expansion of patient autonomy in CPR choices.
  • To introduce the DNAR-X (Do Not Attempt Resuscitation-Except) code as a patient-centered alternative.

Main Methods:

  • Ethical analysis of current CPR protocols.
  • Conceptual development of the DNAR-X code.
  • Review of patient rights in medical decision-making.

Main Results:

  • Existing CPR protocols inadequately address patient preferences and autonomy.
  • The DNAR-X code offers a nuanced approach, allowing conditional acceptance or refusal of CPR.
  • Implementing DNAR-X can significantly improve patient control over their medical interventions.

Conclusions:

  • Patients require comprehensive information on CPR outcomes to make informed decisions.
  • The DNAR-X code represents a vital advancement in respecting patient autonomy and values.
  • Expanding resuscitation options beyond a simple yes/no is ethically imperative.

Keywords:
CPRDNARDNAR-XMOELIPOLSTResuscitationmedical ethics

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