I am disturbed by the implications of the conclusion of Maksoud et al that "total hospital and professional charges are significantly lower when a patient is admitted with an established nonresuscitation order compared with those for whom a do-not-resuscitate order is established while in the hospital."1 Costs are less because less is done for the patient diagnostically and therapeutically. Unless a patient gives specific instructions not to be treated with dialysis, antibiotics, blood transfusions, and the like, these modalities of treatment should be given where appropriate. To withhold anything but cardiopulmonary resuscitation is not part of a do-not-resuscitate order. The latter is limited to resuscitation following cardiopulmonary arrest.
Patients should be encouraged to make their wishes known through advance directives such as living wills or health care proxy designations. However, the patient's desire not to be resuscitated does not limit in any way the patient's right to receive all