New Do-Not-Resuscitate Policies

Hermann Small, MD
Arch Intern Med. 1994;154(13):1536-1539. doi:10.1001/archinte.1994.00420130134018.
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The article by Murphy and Finucane on new do-not-resuscitate (DNR) policies1 leaves the reader perplexed. First, the policies are not new; second, the rationale for the new policies is contradicted by the authors themselves and the data available in the literature.

The new DNR policies the authors propose are really a new procedure for development of DNR policies. The idea is that community members along with hospital officials, professional groups, and governmental groups propose new DNR policies for the hospitals of a city. This community-based development of hospital policies is hardly a novel idea. Oregon health decisions began developing what they called "informed community consent" on the whole range of terminating care issues.2 Similarly, for years, Emanuel3 has advocated community-based decision-making not just for terminating care but also for allocating scarce medical resources. In his book,4 he has elaborated the theoretical justification for such community-based policy


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