The Prevalence and Design of Hospital Protocols Limiting Medical Treatment

Steven H. Miles, MD; D. Gay Moldow, BSN, MSW
Arch Intern Med. 1984;144(9):1841-1843. doi:10.1001/archinte.1984.00350210167028.
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Do-not-resuscitate (DNR) orders and supportive-careonly (SCO) care plans are two ways of implementing limited levels of medical intervention for patients with advanced irreversible diseases. A DNR order overrides hospital policy that resuscitation will be attempted on inpatients suffering a cardiopulmonary arrest. Orders to withhold resuscitation are endorsed by the American Heart Association1 and by the recent President's Commission2 on biomedical ethics, and several hospital policies have been published.3-5 In 1981, the Minnesota Medical Association (MMA) became the first state medical society to adopt DNR guidelines.2 Supportive-care-only refers to programs of palliative care intending to maintain the comfort, dignity, and hygiene of profoundly debilitated and often terminally ill patients. Supportive-care-only plans are not as explicitly or concisely defined in the medical literature as DNR orders, but are described in the ethics literature6 and illustrated by hospital policies providing for varying levels of medical intervention.7-9



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