Do Not Resuscitate Orders:
Case 2 Discussion
Mrs. W is elderly and has a diagnosis of metastatic cancer. In several prospective outcome studies of CPR in the hospital, patients like Mrs. W had 0% survival. Thus CPR for Mrs. W could be called "futile."
Nevertheless, current policy at UWMC/Harborview and the VAMC state that one should not write a DNR order, even if CPR is judged to be futile, without patient or family concurrence. Rather, you should allow Mrs. W some time to come to grips with her diagnosis, while periodically re-addressing the CPR question with her. This is best done in the context of other medical decision that occur during her care. It is important to review other care goals with her, to allay possible fear that a DNR order may mean she will be abandoned or not cared for.
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