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Industry: Email Alert RSS FeedPractical guidelines for do-not-resuscitate orders
American Family Physician, Nov 1, 1994 by Mark H. Ebell
In such a meeting, the physician serves as facilitator. He or she should focus discussion on the patient and use language that all participants can understand. Molloy discusses other strategies for family meetings, including the following: (1) outline the decisions as a series of simple choices; (2) nominate one member of the family to communicate with the health care team (in the case of an incompetent patient); (3) establish a realistic timeline to help the family focus on the decision, and (4) be consistent in your description of the patient and the medical condition when speaking with family members.[28]
In the event of a more serious or intractable conflict that cannot be resolved by multiple family meetings, other measures may be necessary. A consultation with an ethicist or ethics committee may provide useful insight and structure for the discussion. Transfer of care to another physician, team or facility may help resolve conflicts between the medical staff and the patient or family. Finally, some conflicts may result in legal action by one of the concerned parties, although this should be a last resort.
Final Comment
The appropriate use of DNR orders is an important way to prevent unnecessary suffering and the misallocation of scarce medical resources.[29] Most patients will welcome an open and caring discussion of their alternatives regarding resuscitation with a physician who is prepared to discuss these issues.
REFERENCES
[1.] Jonsson PV, McNamee M, Campion EW. The "Do not resuscitate" order. A profile of its changing use. Arch Intern Med 1988;148:2373-5.
[2.] Jayes RL, Zimmerman JE, Wagner DP, Draper EA, Knaus WA. Do-not-resuscitate orders in intensive care units. Current practices and recent changes. JAMA 1993;270:2213-7.
[3.] Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA 1960;173:1064-7.
[4.] Meisel A. The right to die: 1991 cumulative supplement no. 2. New York: Wiley Law Publications, 1991:120-1.
[5.] Ebell MH, Eaton TA. Flow chart for the interpretation of do-not-resuscitate order statutes [editorial]. J Fam Pract 1992;35(2):141-3.
[6.] Public Law 101-508, 104 Stat 1388-321. Washington, D.C.: U.S. Government Printing Office, 1990.
[7.] Michigan Act 3, Public Acts of 1993, Senate Bill No. 211.
[8.] Council on Ethical and Judicial Affairs, American Medical Association. Guidelines for the appropriate use of do-not-resuscitate orders. JAMA 1991;265:1868-71.
[9.] Joint Commission on Accreditation of Healthcare Organizations. AMH: accreditation manual for hospitals. Oakbrook Terrace, Ill.: The Joint Commission, 1992.
[10.] New York State Task Force on Life and the Law. Do not resuscitate orders the proposed legislation and report of the New York State Task Force on Life and the Law. Albany, N.Y.: The Task Force, 1986:6-7.
[11.] Tomlinson T, Brody H. Ethics and communication in do-not-resuscitate orders. N Engl J Med 1988;318:43-6.
[12.] Lipsky MS. Indications for DNR orders: a review. Resid Staff Physician 1986;32:47-51.
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