Doctors in limbo: the United States 'DNR' debate

Cardiopulmonary resuscitation is unlike any other medical intervention in its emotional impact. Its original use in reversible conditions has been replaced by its expected use in irreversible ones. The history of this transformation and its psychological concommitants are reviewed. New York State is unusual in having a 'DNR' law where resuscitation is the default position unless actively refused by patient or surrogate. The paradoxical genesis of this law, and its complex effect on a tertiary care hospital are described. Attention is focused on the emotional stresses on medical staff, and the extensive teaching program mounted by the institution's ethics committee to enable a positive adaptation. The difficulties inherent in surrogate decision-making are also reviewed.