The 1988 DNR Reforms: A Comparative Study of the Impact of the New York DNR Law and the Jcaho Accreditation Requirements

  • Robert Baker
  • Martin A. Strosberg
  • Josef Schmee
  • I. Alan Fein
  • Virginia Jonas Dersch
  • Jonathan Bynum
  • Philip Oates
Part of the Philosophy and Medicine book series (PHME, volume 48)


The DNR reforms of 1988, a coincident trial of both the legislative and the self-regulatory routes to reform, provide an ideal vehicle for assessing the impact of bioethical reform. They can be construed as inadvertant “natural experiment,” a comparative trial of the effects of reforming DNR practices by means of an amendment to the state’s public health law, or by means of a change in the accreditation policies of the Joint Commission on Accreditation of Health-Care Organizations (hereafter, JCAHO). In the study described below, we attempt to assess the impact of these two different routes to mandatory bioethical reform: the JCAHO’s latitudinarian professional self-regulative approach; and New York’s use of a statute enforced by the state department of health and the law courts.


Medical Director Nursing Director Persistent Vegetative State Terminal Patient Medical Futility 
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  1. 1.
    Baker, R., Dersch, V. and Strosberg, M.: 1989, ‘Physicians’ Attitudes Towards Using Deception’, Journal of the American Medical Association 262, 2233.CrossRefGoogle Scholar
  2. 2.
    Bedell, S. and Delbanco, T.: 1984, ‘Choices About Cardiopulmonary Resuscitation in the Hospital’, New England Journal of Medicine 310, 1089–1093.CrossRefGoogle Scholar
  3. 3.
    Bedell, S. et al.: 1986, ‘Do-Not-Resuscitate Orders for Critically Ill Patients in the Hospital: How Are They Used and What Is Their Impact?’ Journal of the American Medical Association 256, 233–237.CrossRefGoogle Scholar
  4. 4.
    Blackhall, L.: 1987, ‘Must we always use CPR?’ New England Journal of Medicine 317, 1281–1284.CrossRefGoogle Scholar
  5. 5.
    Brody, B.: 1990, ‘Quality of Scholarship in Bioethics’, Journal ofMedicine and Philosophy 15, 161–178.CrossRefGoogle Scholar
  6. 6.
    Crane, D.: 1977, The Sanctity of Social Life, Transaction Books, New Brunswick, NJ.Google Scholar
  7. 7.
    Hastings Center: 1987, Hastings Center Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying, Indiana University Press, Bloomington, IN.Google Scholar
  8. 8.
    Jonsson, P., McNamee, M., Campion, E.: 1988, ‘The Do Not Resuscitate Order: A Profile of its Changing Use’, Archives of Internal Medicine 148, 2373–2375.CrossRefGoogle Scholar
  9. 9.
    Kamer, R., Dieck, E., McClung, J., et al.: 1990, ‘Effect of New York State’s Do-Not-Resuscitate Legislation on In-hospital Cardiopulmonary Resuscitation Practice’, American Journal of Medicine 88, 108–111.CrossRefGoogle Scholar
  10. 10.
    Kapp, M., Lo, B.: 1986, ‘Legal Perceptions and Medical Decision Making’, Millbank Quarterly 64, Suppl. 2, 163–202.CrossRefGoogle Scholar
  11. 11.
    Lantos, J., Singer, P., Walker, R., et al.: 1989, ‘The Illusion of Futility in Clinical Practice’, American Journal of Medicine 87, 81–84.CrossRefGoogle Scholar
  12. 12.
    Lo, B., McLeod, G., Saika, G.: 1986, ‘Patient Attitudes to Discussing Life-sustaining Treatment’, Archives of Internal Medicine 146, 1613–1615.CrossRefGoogle Scholar
  13. 13.
    Longo, D., Warren, M., Roberts, J., Dunlop, G.: 1988, G.: 1988, ‘Extent of DNR Policies Varies Across Healthcare settings’, Healthprogress, June 1988, 66–73.Google Scholar
  14. 14.
    Moses, L., Emerson, J., Hosseini, H.: 1984, ‘Analyzing Data From Ordered Categories’, New England Journal of Medicine 311, 442–448.CrossRefGoogle Scholar
  15. 15.
    Rest, J.: 1979, Moral Development: Advances in Research and Theory, Praeger Publishers, New York.Google Scholar
  16. 16.
    Schneiderman, L, Jecker, N, Jonsen, A.: 1990, Medical Futility: Its Meaning and Ethical Implications, Annals of Internal Medicine 112, 12–36.Google Scholar
  17. 17.
    Swidler, R.: 1989, ‘The Presumption of Consent in New York State’s Do-Not-Resuscitate Law’, New York State Journal of Medicine 89, 69–72.Google Scholar
  18. 18.
    Wilcoxon, F.: 1945, ‘Individual Comparisons by Ranking Methods’, Biometrics 1, 80–83.CrossRefGoogle Scholar
  19. 19.
    Youngner, S.: 1988, ‘Who Defines Futility?’ Journal of the American Medical Association 260, 2096–2097.CrossRefGoogle Scholar
  20. 20.
    Youngner, S.: 1990, ‘Futility in Context’, Journal of the American Medical Association 264, 1295–1296.CrossRefGoogle Scholar
  21. 21.
    Zimmerman, J.E., Knaus, W.A., Sharpe, S.M. et al.: 1986. ‘The Use and Implications of Do Not Resuscitate Orders in Intensive Care Units’, Journal of the American Medical Association 255, 351–356.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

Authors and Affiliations

  • Robert Baker
  • Martin A. Strosberg
  • Josef Schmee
  • I. Alan Fein
  • Virginia Jonas Dersch
  • Jonathan Bynum
  • Philip Oates

There are no affiliations available

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