Unilateral do-not-attempt-resuscitation orders and ethics consultation: A case series

Objective: To describe the role of an ethics consultation service in unilat erally withholding cardiopulmonary resuscitation, Design: Retrospective case series of 31 ethics consultations regarding unil ateral do-not-attempt-resuscitation orders between 1992 and 1996, Setting: A large, urban, academic medical center. Measurements and Main Results: Patient characteristics, physicians' rationa le for withholding cardiopulmonary resuscitation, ethics consultants' recom mendations, and patient outcomes were measured. The consultation service ag reed with the medical team's intent to withhold cardiopulmonary resuscitati on in 25 cases, but a unilateral do-not-attempt-resuscitation order was wri tten in only seven of these. in 17 cases, the disagreement between the phys ician and the patient or surrogate over code status was resolved in a confe rence organized by the ethics service. Conclusions: The process of ethics consultation is useful in resolving disa greements over withholding cardiopulmonary resuscitation and other treatmen t and can frequently result in a consensus. Hospital policies that permit u nilateral treatment limitation should be based on a model that is process-b ased and that encourages interdisciplinary participation in decision-making , such as that recently proposed by the Houston Task Force.