Detours on the Road to Autonomy

Abstract

IN 1988 New York State passed legislation regulating the writing of do-not-resuscitate (DNR) orders. The legislation was intended to preserve and maximize patient autonomy. However, there have been 2 unintended consequences: futile resuscitation has become institutionalized and patients who want to protect themselves against the terror of approaching death by clinging to denial are deprived of this self-protective device, unless the physician fails to obey the law. In 1982 a grand jury found that a New York City hospital had been using covert DNR orders and routinely excluding patients from decisions about their resuscitation. 1 A subsequent New York State task force was charged with drafting legislation to regulate the writing of DNR orders, in particular to fashion a law that preserved and maximized patient autonomy. To that end it proposed that exceptions to the discussion of a DNR order directly with the patient be narrowly limited. The law was