New Do-Not-Resuscitate Policies: A First Step in Cost Control
Murphy, Donald J.
Finucane, Thomas E.
Archives of Internal Medicine. 1993 Jul 26; 153(14): 1641-1648.
To control the cost of health care and to improve access to care for the uninsured, our society will have to set limits on health care use. We believe that new do-not-resuscitate (DNR) policies would be just and relatively painless ways of beginning to set these limits. New policies could be developed with public input at the hospital, city, or county levels. We suggest a DNR policy that eliminates cardiopulmonary resuscitation (CPR) for certain groups of people who are near death and that CPR no longer be considered part of standard care for these patients. The major rationale for this policy change is cost control....The policy would have some disadvantages in that it would limit individual patient autonomy, be legally risky, depend on imprecise data, be difficult to communicate, and result in an earlier death for some patients who would have wanted CPR and who would have survived as a result of CPR. We believe the advantages outweigh the disadvantages.
Aged; Aids; Autonomy; Biomedical Technologies; Cancer; Chronically Ill; Costs and Benefits; Critically Ill; Death; Decision Making; Dementia; Economics; Futility; Guidelines; Health; Health Care; Health Care Delivery; Hospitals; Institutional Policies; Justice; Legal Liability; Liability; Nursing Homes; Patients; Prognosis; Public Participation; Public Policy; Religion; Resource Allocation; Resuscitation; Resuscitation Orders; Risks and Benefits; Selection for Treatment; Socioeconomic Factors; Terminally Ill; Uncertainty; Withholding Treatment;
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