Conditional Permission to Not Resuscitate: A Middle Ground for Resuscitation

摘要

Every decision to perform or withhold cardiopulmonary resuscitation (CPR) has ethical implications that are not always well understood. Value-based decisions with far-reaching consequences are made rapidly, based on incomplete or possibly inaccurate information. For some patients, skilled, timely CPR can restore spontaneous circulation, but for others, success may either be unobtainable or bring serious iatrogenic consequences. Because CPR is an aggressive process yielding mixed results, patients must be informed about the likelihood of its positive and adverse outcomes. In considering whether to accept or refuse it, patients should also be given a realistic set of alternatives. Current protocols limit patients' options by restricting them to a choice between accepting or refusing CPR. Adding a "middle" code, DNAR-X (Do Not Attempt ResuscitationeExcept), significantly expands patients' right to control what happens to their bodies by allowing them to stipulate CPR in some circumstances but not in others. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.