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Advance Directives for Health Care - Do Not Orders

physician clinical patient medical law policy

Many acute and long-term care providers have developed and implemented written protocols regarding physician orders to withhold particular kinds of medical treatments under specified circumstances taking place at some time in the future. Such orders are a variety of advance directive, and ordinarily are written by the physician with the agreement of the competent patient or the incompetent patient's proxy. Much attention has focused on Do Not Resuscitate (DNR) orders to withhold cardiopulmonary resuscitation (CPR) in the event of a patient's cardiac or respiratory arrest. Other forms of prospective physician instructions to withhold or limit life-sustaining medical treatments, such as Do Not Hospitalize or Do Not Intubate orders, also may be entered in the patient's medical record. The PSDA requires covered health care providers to adopt DNR policies.

In many places, policies and procedures for withholding potential life-sustaining medical treatments, such as CPR, from dying home-care patients have also been developed. Over half the states have passed statutes that explicitly authorize DNR, or No Code, orders to be applied in situations of cardiac or respiratory arrest taking place outside of a health care institution. Such orders, written in advance by the physician in consultation with the patient or proxy, would allow emergency medical personnel who are called to a dying patient's home to refrain from making an attempt to resuscitate the patient.

MARSHALL B. KAPP

BIBLIOGRAPHY

American Medical Association Council on Ethical and Judicial Affairs. "Optimal Use of Orders Not to Intervene and Advance Directives." Psychology, Public Policy, and Law 4 (1998): 668–675.

CANTOR, N. L. "Making Advance Directives Meaningful." Psychology, Public Policy, and Law 4 (1998): 629–652.

KING, N. M. P. Making Sense of Advance Directives, rev. ed. Washington, D.C.: Georgetown University Press, 1996.

LIANG, B. A. Health Law & Policy. Boston: Butterworth-Heinemann, 2000.

LYNN, J., and HARROLD, J. Handbook for Mortals: Guidance for People Facing Serious Illness. New York: Oxford University Press, 1999.

MEISEL, A. The Right to Die. 2d ed. New York: Wiley Law Publications, 1995.

RICH, B. A. "Personhood, Patienthood, and Clinical Practice: Reassessing Advance Directives." Psychology, Public Policy, and Law 4 (1998): 610–628.

ULRICH, L. P. The Patient Self-Determination Act: Meeting the Challenges in Patient Care. Washington, D.C.: Georgetown University Press, 1999.

INTERNET RESOURCES

Partnership for Caring. www.partnershipforcaring.org A national organization dedicated to public education and advocacy regarding the quality of care provided to individuals who are approaching the end of life.

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