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Incoming patients across the country, as a requirement of the Patient Self-Determination Act,’ are met on the threshold of hospitals and informed of their right to accept or refuse treatment. They are also offered information about formulating advance directives to govern the use of lifesustaining treatment should they lose decision-making capacity. It is generally assumed that instructional directives covering specific treatment interventions must be followed in every setting within the hospital.’ This assumption is reinforced by the requirements of the Patient Self-Determination Act, since options accepted by patients at the portals of a health care institution are likely to be perceived as in force throughout the facility. The “Do-Not-Resuscitate” (DNR) order is a specific directive mandating that cardiopulmonary resuscitation (CPR), a dramatic intervention that can restore breathing and heartbeat to patients who have experienced cardiac arrest, should not be performed on patients. Patients or their surrogates who agree to the entry of DNR orders into their medical records usually do so because they believe CPR would be useless or disproportionately burdensome.
Cohen et al. (Wed,) studied this question.