COMPARISON OF MEDICAL AND NURSING ATTITUDES TO RESUSCITATION AND PATIENT AUTONOMY BETWEEN A BRITISH AND AN AMERICAN TEACHING HOSPITAL

In the last 30 years, cardiopulmonary resuscitation (CPR) has evolved from an intervention indicated only in cases of acute insult to an oth erwise healthy body to a default measure employed in virtually all cas es of cardiac failure. The high cost and low efficacy rat-of CPR has p rovoked questions about the moral and economic wisdom of its routine u se, particularly for elderly patients with serious comorbidity. This p aper presents the results of a comparative study of decision making pr actices concerning ''Do-Not-Resuscitate'' (DNR) orders in British and American hospitals. Thirty-four physicians and nurses in one American and one British hospital were interviewed about their decision making practices. Qualitative methods of data analysis were employed. The stu dy revealed that while the American and British hospitals had adopted similar formal protocols for DNR decision making, in practice the Brit ish physicians often made DNR decisions unilaterally, whereas the Amer ican physicians sought the patient's or surrogate's consent in every i nstance, even where it was no-legally required. The British decision m aking model enables physicians to reduce the inappropriate use of resu scitation, but at the expense of patient autonomy. In contrast, the Am erican approach fully respects patient autonomy, but except in cases o f medical futility grants physicians no authority to refuse to render treatments that are in their judgment contraindicated. (C) 1998 Elsevi er Science Ltd. All rights reserved.