Taking Stock of Policies for Do-Not-Resuscitate Orders: Perception and Practice

  • Tracy E. Miller
Part of the Philosophy and Medicine book series (PHME, volume 48)


In the waning hours of the 1987 legislative session, the New York State Legislature passed Article 29-B of the Public Health Law, commonly known as the do-not-resuscitate (DNR) law [25]. Based on a proposal by the New York State Task Force on Life and the Law [26], the law embodied a widely accepted consensus about policies that should guide advance decisions to withhold cardiopulmonary resuscitation (CPR). That consensus reflected a judgment that CPR offered little or no benefit for some patients and should not be provided. The consensus also recognized the participation of patients, or surrogates for incapacitated patients, as an important part of the process for deciding whether an order to withhold cardiopulmonary resuscitation should be entered for patients in a hospital or other health care facility.


Cardiopulmonary Resuscitation Public Hearing Critical Care Physician Grand Jury 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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    52 N.Y.2d 363, 420 N.E.2d 63, cert. denied, 454 U.S. 858 (1981).Google Scholar
  2. 2.
    Act of July 4, 1991. ch. 370 (amending N.Y. Public Health Law, 2965, 2967), this volume, pp. 445–454.Google Scholar
  3. 3.
    Ahronheim, J., Maheswaran S., and Rosenberg, C.: 1992 ‘Impact of Do-Not-Resuscitate Legislation on the Use of Cardiopulmonary Resuscitation in Three Teaching Hospitals’, New York State Journal of Medicine, 92:181–185. See also this volume, pp. 235–240.Google Scholar
  4. 4.
    Assembly Bill No. A 7166, New York State Assembly, May 1993Google Scholar
  5. 5.
    Baker, R.: 1995, ‘The Legitimation and Regulation of DNR Orders’, this volume, pp. 33–101.Google Scholar
  6. 6.
    Baker, R.: 1995, ‘A Review of the Empirical Studies of the DNR Law and a Rejoinder to Tracy Miller’, this volume, pp. 333–346.Google Scholar
  7. 7.
    Baker, R., Strosberg, M., et al.: 1994, ‘The 1988 Do-Not-Resuscitate Reforms: A Comparative Study of the Impact of the New York DNR Law and the JCAHO Accreditation Requirements for DNR Policy’, this volume, pp. 263–301.Google Scholar
  8. 8.
    Bedell, S. and Pelle, D. 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, 233–37.CrossRefGoogle Scholar
  9. 9.
    Bedell, S. and Delbanco, T.: 1984, ‘Choices About Cardiopulmonary Resuscitation in the Hospital: When Physicians Talk with Patients’, New England Journal of Medicine 310, 1089–93.CrossRefGoogle Scholar
  10. 10.
    Blackhall, L.: 1987, ‘Must We Always Use CPR?’, New England Journal of Medicine 317, 1281–5.CrossRefGoogle Scholar
  11. 11.
    Council on Ethical and Judicial Affairs, American Medical Association: 1991, ‘Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders’, Journal of the American Medical Association 265, 1868–71.CrossRefGoogle Scholar
  12. 12.
    Dersch, V.: 1992, Summary of Written Responses by Critical Care Nurses, Unpublished manuscript version of the essay in this volume.Google Scholar
  13. 13.
    Dersch, V.: 1995, ‘Differences in Clinician Reactions to the New York DNR’, this volume, pp 303–321.Google Scholar
  14. 14.
    Fader, R., and Gambert, et al.: 1989, ‘Implementing a Do-Not-Resuscitate (DNR) Policy in a Nursing Home’, 1989, Journal of the American Geriatrics Society 37, 544–48.Google Scholar
  15. 15.
    Farber, S.: 1988, [Letter] New England Journal of Medicine 318, 1757–58.Google Scholar
  16. 16.
    Finucane, T., Shumway, J. et al.: 1988, “Planning with Elderly Outpatients for Contingencies of Severe Illness,” Journal of General Internal Medicine 3, 322–25.CrossRefGoogle Scholar
  17. 17.
    High, D.: 1988, ‘All in the Family: Extended Autonomy and Expectations in Surrogate Health Care Decision-Making’, Gerontologist 28, Suppl.: 46–51.CrossRefGoogle Scholar
  18. 18.
    High D., and Turner, H.: 1987, ‘Surrogate Decision-Making: The Elderly’s Familial Expectations’, Theoretical Medicine 8, 303–20.CrossRefGoogle Scholar
  19. 19.
    Kamer, R., Dieck, E. et al.: 1990 ‘Effect of New York State’s Do-Not-Resuscitate Legislation on In-Hospital Cardiopulmonary Resuscitation Practice’, American Journal of Medicine, 88, 108–11, reprinted in this volume, pp. 227–234.CrossRefGoogle Scholar
  20. 20.
    Lantos, J., Singer, P. et al.: 1989, ‘The Illusion of Futility in Clinical Practice’, American Journal of Medicine 87, 81–84.CrossRefGoogle Scholar
  21. 21.
    Lo, B., McLeod, G. et al.: 1986, ‘Patient Attitudes to Discussing Life-Sustaining Treatment’, Archives of Internal Medicine 146, 1613–1615.CrossRefGoogle Scholar
  22. 22.
    Longo, E.: 1988, ‘Extent of DNR Policies Varies Across Health Care Settings’, Health Progress June, 66–73.Google Scholar
  23. 23.
    Miller, T.: 1995, ‘An Assessment of the Union College Study and a Response to Robert Baker’s Analysis of the DNR Law’, this volume, pp. 325–332.Google Scholar
  24. 24.
    Murphy, D.: 1988, ‘Do-Not-Resuscitate Orders: Time for Reappraisal in Long-term Care Institutions’, Journal of the American Medical Association 260, 2098–2101.CrossRefGoogle Scholar
  25. 25.
    New York Public Health Law Art. 29-B, 2960–2978 (McKinney 1992), this volume, pp. 381–413.Google Scholar
  26. 26.
    New York State Department of Health, Medical Society of New York State, and the Hospital Association of New York State: 1990, ‘Do Not Resuscitate Orders: Questions and Answers for Health Care Professionals’, this volume, pp. 415–438.Google Scholar
  27. 27.
    New York State Task Force on Life and the Law.: 1986, Do Not Resuscitate Orders: The Proposed Legislation and Report of the New York State Task Force on Life and the Law, New York, New York. Reprinted in part in this volume, pp. 3–7, and pp. 381–413.Google Scholar
  28. 28.
    New York State Task Force on Life and the Law: 1992, When Others Must Choose: Deciding for Patients without Capacity, New York.Google Scholar
  29. 29.
    Ouslander, J., Tymchuk, A., and Rahbar, B.: 1989, ‘Health Care Decisions Among Elderly Long-Term Care Residents and Their Potential Proxies’, Archives of Internal Medicine 149, 1367–72.CrossRefGoogle Scholar
  30. 30.
    Plowe, C.: 1988, ‘Letter to the Editor’, New England Journal of Medicine 318, 1758.Google Scholar
  31. 31.
    Praeger, K.: 1989, ‘How CPR Can Threaten the Desperately Ill’, Wall Street Journal, March 9.Google Scholar
  32. 32.
    Quill, T. and Bennett, N.: 1995, ‘The Effects of a Hospital Policy and State Legislation on Resuscitation. Orders for Geriatric Patients’, this volume, pp. 241–250.Google Scholar
  33. 33.
    Report of the Special January Third Additional 1983 Grand Jury concerning “Do not resuscitate procedures at a certain hospital in Queens” (Sup. Ct., Queens Co., Feb. 8, 1984).Google Scholar
  34. 34.
    Rosner, F.: 1988, ‘Must We Always Offer the Option of CPR: The Law in New York’, Journal of the American Medical Association 260, 3129.CrossRefGoogle Scholar
  35. 35.
    Schneiderman, L., Jecker, N., and Jonsen, A.: 1990, ‘Medical Futility: Its Meaning and Ethical Implications’, Annals of Internal Medicine 112, 949–54.Google Scholar
  36. 36.
    Schonwether, R., Tesdale, T. et al.: 1991, ‘Educating the Elderly Cardiopulmonary Resuscitation Decisions Before and After Intervention’, Journal of the American Geriatric Society 39, 372–377.Google Scholar
  37. 37.
    Shmerling, R., Bedell, S. et al.: 1988, ‘Discussing Cardiopulmonary Resuscitation: A Study of Elderly Outpatients’, Journal of General Internal Medicine 3, 317–321.CrossRefGoogle Scholar
  38. 38.
    Spritz, N.: 1994, ‘The New York State DNR Law: Views of the members of the New York Chapter of the American College of Physicians’, this volume, pp. 251–261.Google Scholar
  39. 39.
    Steinberg, A. Fitter, J. et al.: 1986, ‘Patient Participation in Treatment Decision-Making in the Nursing Home: The Issue of Competence’, Gerontologist 26, 362–366.CrossRefGoogle Scholar
  40. 40.
    Swender, P.: 1989, ‘Reflections on the New York Do-Not-Resuscitate Law’, New York State Journal of Medicine 89, 57–58.Google Scholar
  41. 41.
    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
  42. 42.
    Testimony at Public Hearings before the New York State Senate amd Assembly Health Committees, February, 1987.Google Scholar
  43. 43.
    Tomlinson, T., and Brody, H.: 1990, ‘Futility and the Ethics of Resuscitation’, Journal of the American Medical Association 264, 1276–80.CrossRefGoogle Scholar
  44. 44.
    Uhlmann, R., Pearlman R. and Cain, K.: 1988, “Physicians’ and Spouses’ Predictions of Elderly Patients’ Resuscitation Preferences,” Journal of Gerontology, 43, M115–21.CrossRefGoogle Scholar
  45. 45.
    Wetle, T., Levkoff, S. et al.: 1988 ‘Nursing Home Resident Participation in Medical Decisions: Perceptions and Preferences’ Gerontologist 28, Suppl.: 32–38.CrossRefGoogle Scholar
  46. 46.
    Youngner, S.: 1988, ‘Who Defines Futility?’, Journal of the American Medical Association 260, 2094–5CrossRefGoogle Scholar
  47. 47.
    Zweibel, N. and Cassel, C.: 1989, ‘Treatment Choices at the End of Life: A Comparison of Decisions by Older Patients and Their Physician Selected Proxies’, Gerontologist 29, 615–621.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

Authors and Affiliations

  • Tracy E. Miller

There are no affiliations available

Personalised recommendations