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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
Chapter
Part of the Philosophy and Medicine book series (PHME, volume 48)

Abstract

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.

Keywords

Medical Director Nursing Director Persistent Vegetative State Terminal Patient Medical Futility 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  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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