Do not resuscitate and the removal of life support

Although the right to terminate life-sustaining treatment is clear from the medical, ethical, and moral perspective, the legal methodology is fragmented and variable depending upon the jurisdiction in which you practice. A few general principles do emerge which may be useful for the clinical gastroenterologist. DNR orders may be entered into a patient's orders provided the patient, if competent, or his or her family or guardian, if the patient is incompetent, gives informed consent. In no circumstance should the physician enter the order without obtaining the responsible party's informed consent. Proper documentation in the chart is recommended and the views of an ethics-type committee are desirable if available. If your hospital or institution does not have a DNR policy, encourage its development. Termination of life support decisions should be made upon sober reflection by the physician, patient, and/or family or guardian. The decision must be based on a full appreciation of the underlying medical illness, the prognosis and expectation for meaningful recovery, and the physician should be certain to obtain informed consent. The decision should not be made hastily, keeping in mind that the passage of time allows for a more dispassionate decision by all of the parties. Submission of the case before an ethics or prognosis committee is recommended. A hospital or institutional policy regarding termination decision-making is highly desirable. If unsure, legal counsel should be sought before terminating life support. Jurisdictions which define death by both cardiopulmonary and neurologic criteria make the termination decision easier in that brain-dead patients can be removed from life support without risk of liability.(ABSTRACT TRUNCATED AT 250 WORDS)