Ethics and communication in do-not-resuscitate orders

Three rationales for do-not-resuscitate (DNR) orders are described: no medical benefit, poor quality of life after resuscitation, and poor quality of life before resuscitation. The authors argue that many recommendations concerning resuscitation are vague and fail to take into account the distinctions among the rationales. They claim that these distinctions make a difference for the ethics of DNR decisions, for communication with patients and their families, for communication among health personnel, and for hospital DNR policies. Contrasts among rationales are discussed that pertain to the relevance of patient values, generalizability to treatments other than resuscitation, impact on communication, and implications for institutional policies. (KIE abstract)