DNAR as Default Status: Desirable in Principle, Difficult in Practice

In her recent article, Barbara J. Daly¹ argues for a reversal of the current norm, which presumes that every patient receives cardiopulmonary resuscitation (CPR) unless there is a specific physician order (eg, do not attempt resuscitation, physician orders for life-sustaining treatment) to the contrary.

Specifically, Daly wants to “restrict use of CPR to those patients who provide adequately informed consent and for whom CPR has a reasonable chance of success (ie, discharge from the hospital without significant impairment in cognitive status).”^1 (p378) This argument to reverse the default status has been pushed for many years, and I am sympathetic to it. But whereas Daly raises and cogently responds to 5 important objections, she leaves a rather central issue untouched.

That is, she exempts from her proposal those patients for whom there is a “meaningful chance of producing a desirable outcome.”^1 (p379) But this phrase, like those in...