'Do not resuscitate' orders: the need for a policy.

The use of 'do not resuscitate' (DNR) orders is widespread in UK hospitals, but until recently there has been no formal policy for this practice. The decision not to resuscitate should be made on ethical and medical grounds. The ethical implications for such decisions are explored. A review of current practice reveals considerable variation in the way in which DNR orders are made. Patients are rarely involved in the decision. There have been failures of communication between doctors and nurses, and between consultants and their juniors. These issues have now come to public and professional attention. There is a need for coherent national and local resuscitation policies that should take into account the medical, ethical and practical aspects of DNR decision making.