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Reconsidering Hospital Policy

J. Chris Hackler, PhD; F. Charles Hiller, MD

JAMA. 1990;264(10):1281-1283.

Abstract
Hospital policies typically require that cardiopulmonary resuscitation be attempted unless a do-not-resuscitate order has been written, and they further require that family permission for the order be obtained. This sometimes forces physicians to perform procedures that are useless or that add to the patient's suffering without corresponding benefit. Policies should be changed to allow physicians to write a do-not-resuscitate order over family objections when (1) the patient lacks decision-making capacity, (2) the burdens of treatment clearly outweigh the benefits, (3) the surrogate does not give an appropriate reason in terms of patient values, preferences, or best interests, and (4) the physician has made serious efforts to communicate with the family and to mediate the disagreement. Furthermore, when resuscitation would clearly provide no medical benefit to the patient, policy should not require that it be discussed with either the patient or the family.

(JAMA. 1990;264:1281-1283)

Author Affiliations
From the Divisions of Medical Humanities (Dr Hackler) and Pulmonary and Critical Care Medicine (Dr Hiller), University of Arkansas for Medical Sciences, and John L. McClellan Memorial Veterans Hospital (Dr Hiller), Little Rock, Arkansas.

Footnotes
Reprint requests to Division of Medical Humanities, University of Arkansas for Medical Sciences, 4301 W Markham St, Mail Slot 646, Little Rock, AR 72205 (Dr Hackler).

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