Medicolegal problems associated with do not resuscitate orders

The use and potential abuse of the do not resuscitate (DNR) order has wide-ranging ethical, legal and economic implications. A DNR order is essential for clear communication between health care professionals, but the order itself may affect the care that patients subsequently receive. In addition, the DNR order may be a crucial therapeutic decision point in the care of the critically ill. Although general guidelines exist for withholding resuscitative measures from the terminally ill and general principles have been established, Spanish legislation is ambiguous on a number of points, forcing medical professionals to make difficult choices. This has led to the systematic, indiscriminate application of resuscitative measures, motivated in many cases by the desire to avoid a possible future lawsuit. We believe clearer and more precise legislation should be developed to bring Spanish criteria into line with those of international organizations that provide a common set of guidelines on important issues relating to the right to life and the right to refuse treatment.