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John La Puma, MD
University of Chicago Hospitals and Clinics

JAMA. 1986;255(22):3114.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The important data presented by Zimmerman et al¹ raise clinical-ethical concerns. The authors show that physicians wrote "do not resuscitate" (DNR) orders for 313 intensive care patients an average of just 1.7 days before death or transfer from the intensive care unit. The overall mortality of these patients was 94%. These data suggest that physicians can recognize imminent death well, but may be declaring it with an antemortem order not to resuscitate. This apparent use of the DNR order as "last rites" is particularly disturbing in the intensive care unit, where it may become a selffulfilling prophecy in critically ill but potentially salvageable patients.

Using DNR orders to sanction imminent death and permit the withdrawal of certain therapies is probably not the best use of these orders. In a prospective study at the University of Chicago, many physicians indicated that a DNR order was consistent with . . . [Full Text PDF of this Article]

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