Decisions to withhold treatment from nursing home residents.

Although the ethical issues in clinical care of severely impaired elderly nursing home residents may appear to be the same as those encountered in the acute hospital, they are not. In particular, "do not resuscitate" orders are not of central importance in the nursing home. For the individuals being considered, decisions about limiting routine treatments and whether treatment should include hospitalization are crucial. Establishing an ethical issues team is one means of increasing awareness of ethical issues in patient care and of dealing with these difficult issues more successfully.