Cardiopulmonary resuscitation is a common procedure performed on most patients who die in the hospital. Physicians can write Do-Not-Resuscitate orders for patients who do not want to be resuscitated upon cardiac or respiration arrest. Many empirical studies have been performed to explore issues related to Do-Not-Resuscitate orders. Several studies reported that medical care provided to Do-Not-Resuscitate patients is not clearly defined after Do-Not-Resuscitate orders are written for patients, thus leading to individual interpretation. Some interpretations suggested that Do-Not-Resuscitate patients should be eligible to receive life-extending medical interventions and treatments such as endotracheal intubation, pharmacological cardioversion, or being transferred to an intensive care unit as long as these aggressive interventions are indicated. Others proposed only comfort care be provided to Do-Not-Resuscitate patients after such orders are written.
Since 1998, the State of Ohio has had Do-Not-Resuscitate legislation detailing that individuals can choose one of two different protocols of Do-Not-Resuscitate orders. This legislation allows patients to choose the extent of medical care they wish to receive after they have Do-Not-Resuscitate orders written by physicians. One protocol is Do-Not-Resuscitate Comfort Care (CCO-DNR). This Do-Not-Resuscitate protocol prescribes that only comfort care measures are provided to patients after CCO-DNR orders are written. The other protocol is Do-Not-Resuscitate Comfort Care-Arrest (LE-DNR). This protocol prescribes that a LE-DNR patient is eligible to receive life-extending medical interventions and treatments until he/she experiences cardiac or respiratory arrest, beyond which point only comfort care measures are provided.
This study will examine issues associated with LE-DNR and CCO-DNR orders. First we will explore factors associated with the decision of LE-DNR or CCO-DNR. Medical care provided to LE-DNR, CCO-DNR, and Non-DNR patients as indicated by several different dependent variables will be examined. Lastly, the influence of the two different Do-Not-Resuscitate protocols on the short-term and long-term mortality rates will also be presented in this study.
The results of this study will be expected to provide information about whether the intended goals of medical care for the Do-Not-Resuscitate policy in State of Ohio are actually achieved. In addition, we will also explore whether unintended consequences, if there are any, raise ethical concerns.