DNAR Orders: Resetting the Defaults

The latest issue of JAMA includes some correspondence on Blinderman at al.'s proposal to revise the approach to DNAR status.  In one letter, Dr. Georgiou paints an overly pessimistic picture of the legal obstacles to not performing desired CPR.  In fact, EMTALA is almost always inapplicable to hospital inpatients and it is completely inapplicable to long-term care residents.  More generally, as I have argued here and here, there is hardly as strong or clear a legal prohibition of unilateral DNAR as Dr. Georgiou suggests.        




I especially like Blinderman's response to the letters.  "We can better influence US society if -- instead of focusing on limiting medically futile care . . . -- we stress the obligation to protect patients from harmful and nonbeneficial interventions. . . .  Reframing the reason why CPR is not offered from the principle of medical futility to the principle of nonmaleficence may engender more public acceptance . . . ."  Reminds me of this compelling advertisement on the power of words to change the world: