[Controversies in hospital guidelines for non-resuscitation decisions]

Guidelines regarding non-resuscitation decisions sometimes raise conceptual and ethical questions. Establishing blood circulation and gas exchange is no useful criterium to determine the efficacy of resuscitation. A professional assessment of efficacy or medical futility of resuscitation may involve value judgements. These value judgements should not concern the life of the individual patient, but rather the objective of resuscitation in general. Furthermore, these judgements ought to be grounded on professional consensus. A patient should be informed of a non-resuscitation decision that has been taken, since in the normal course of events resuscitation is the correct treatment. Furthermore, a conversation serves not only to obtain informed consent but also to align the views and expectations of the patient and his treating physician. Suspension of a non-resuscitation policy during operations should be discussed with the patient. A physician is allowed to define the limits to the risks to which he wants to expose the patient.