Family consent to orders not resuscitate. Reconsidering hospital policy.

Hospital policies typically require that cardiopulmonary resuscitation be attempted unless a do-not-resuscitate order has been written, and they further require that family permission for the order be obtained. This sometimes forces physicians to perform procedures that are useless or that add to the patient's suffering without corresponding benefit. Policies should be changed to allow physicians to write a do-not-resuscitate order over family objections when (1) the patient lacks decision-making capacity, (2) the burdens of treatment clearly outweigh the benefits, (3) the surrogate does not give an appropriate reason in terms of patient values, preferences, or best interests, and (4) the physician has made serious efforts to communicate with the family and to mediate the disagreement. Furthermore, when resuscitation would clearly provide no medical benefit to the patient, policy should not require that it be discussed with either the patient or the family.