Abstract
Relatively little is known about the circumstances in which decisions not to resuscitate, documented by no-code orders, are made. By review of medical records and interviews with house staff officers, we studied all medical service patients for whom no-code orders were written and those patients who received cardiopulmonary resuscitation (CPR) between October and December 1980 in the Portland Veterans Administration Medical Center.
Among 1,780 patients admitted, 56 (3.1%) received no-code orders. All decisions were reportedly made by groups of individuals usually including the intern (98% of cases) and resident (93%), but not attending physician (39%). Many patients (43%) were disoriented or obtunded at the time of the no-code decision and 80% of oriented patients did participate in the decision.
Thirty-seven of the 56 no-code patients died during the study. Comparing these with 20 patients who experienced cardiac arrest and did receive CPR, cancer, dementia, incontinence, non-ambulatory, divorced-separated and unemployed statuses were all more prevalent among no-code patients (P<.05).
No-code orders in this Veterans Administration teaching hospital were relatively common and appeared to be made collectively. Participation of patients and attending physicians in the decisions, however, was limited.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bok Sissela. Euthanasia and the care of the dying. Bioscience. 1973 Aug;23(8):461–466. [PubMed] [Google Scholar]
- Brown N. K., Thompson D. J. Nontreatment of fever in extended-care facilities. N Engl J Med. 1979 May 31;300(22):1246–1250. doi: 10.1056/NEJM197905313002204. [DOI] [PubMed] [Google Scholar]
- Crane Diana. Decisions to treat critically ill patients: a comparison of social versus medical considerations. Milbank Mem Fund Q. 1975 Winter;53(1):1–33. [PubMed] [Google Scholar]
- Jonsen A. R., Cassel C., Lo B., Perkins H. S. The ethics of medicine: an annotated bibliography of recent literature. Ann Intern Med. 1980 Jan;92(1):136–136. doi: 10.7326/0003-4819-92-1-136. [DOI] [PubMed] [Google Scholar]
- KOUWENHOVEN W. B., JUDE J. R., KNICKERBOCKER G. G. Closed-chest cardiac massage. JAMA. 1960 Jul 9;173:1064–1067. doi: 10.1001/jama.1960.03020280004002. [DOI] [PubMed] [Google Scholar]
- Lo B., Jonsen A. R. Clinical decisions to limit treatment. Ann Intern Med. 1980 Nov;93(5):764–768. doi: 10.7326/0003-4819-93-5-764. [DOI] [PubMed] [Google Scholar]
- Miles S. H., Cranford R., Schultz A. L. The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy. Ann Intern Med. 1982 May;96(5):660–664. doi: 10.7326/0003-4819-96-5-660. [DOI] [PubMed] [Google Scholar]
- Rabkin M. T., Gillerman G., Rice N. R. Orders not to resuscitate. N Engl J Med. 1976 Aug 12;295(7):364–366. doi: 10.1056/NEJM197608122950705. [DOI] [PubMed] [Google Scholar]