Deciding Whether to Resuscitate

Cardiopulmonary resuscitation (CPR) may be inappropriate for patients with multiple chronic illnesses for whom cardiopulmonary arrest is the inevitable result of a worsening clinical course. Cardiopulmonary resuscitation usually is unsuccessful in such patients; moreover, many patients with chronic or terminal illness do not want the natural course of dying interrupted by CPR. Do not resuscitate (DNR) ordersare orders not to initiate CPR. The principles justifying and the procedures for making DNR orders have been discussed. Guidelines recommend that a DNR order may be written if further medical treatment is futile and/or if the competent patient does not want CPR.1-5 Applying general guidelines, however, may be difficult, as the following cases illustrate. REPORT OF CASESCase 1. —A 30-year-old woman had had Gardner's syndrome and carcinoma of the colon with lung, skin, bone, and epidural metastases. Despite a laminectomy and radiation therapy, she was paraplegic. She was admitted to