Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders

Cardiopulmonary resuscitation (CPR) is routinely performed on hospitalized patients who suffer cardiac or respiratory arrest. Consent to administer CPR is presumed since the patient is incapable at the moment of arrest of communicating his or her treatment preference, and failure to act immediately is certain to result in the patient's death. Two exceptions to the presumption favoring CPR have been recognized, however. First, a patient may express in advance his or her preference that CPR be withheld. If the patient is incapable of expressing a preference, the decision to forgo resuscitation may be made by the patient's family or other surrogate decision maker. Second, CPR may be withheld if, in the judgment of the treating physician, an attempt to resuscitate the patient would be futile. In December 1987, the American Medical Association's Council on Ethical and Judicial Affairs issued a series of guidelines to assist hospital medical staffs in formulating appropriate resuscitation policies. The Council's position on the appropriate use of CPR and do-not-resuscitate orders is updated in this report. (JAMA. 1991;265:1868-1871)