Orders not to resuscitate and the psychiatric hospital

In 1983, the President's Commission for the Study of Ethical Problems in Medicine recommended that all health care institutions be required to develop appropriate policies and procedures for withholding life-sustaining treatment from terminally ill patients. While such policies have been extensively debated, there has been little discussion of the problem in the psychiatric literature. Yet state mental hospitals handle many terminally ill patients, often without having clarified their medical responsibilities. This article focuses on Do Not Resuscitate (DNR) policies in psychiatric settings. It offers illustrative case examples and reviews the important principles and legal decisions that pertain to DNR policies. In hospitals that have no clearly defined medical standards, patients often receive inferior care. The need to develop DNR policies presents an opportunity to discover more thoughtful approaches to medical care in psychiatric hospitals.