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Special Orders

There has been a great deal of debate over the ethics of resuscitation orders. Too often this debate is put in terms of ethics, ignoring the laws that govern consent to treatment and the rights of patients. Family members without the right to consent to trivial medical care are not suddenly enfranchised to consent to critical care for a patient. Difficult as it is for physicians to face a dying patient, this is a necessary part of providing medical care.

If a patient has a living will, a copy of the document should be placed in the chart at the time of hospitalization. Specific orders should be written to reflect the terms of the living will. For instance, if the patient will accept CPR but not accept respirator therapy, there should be a limited code order in the chart that conforms to the policies and procedures of the hospital. If the patient is not hospitalized and is expected to die at home, the family and caretakers should be aware of the procedure to be followed at the time of death. Everyone should realize that if the patient is brought to an emergency room, there will be attempts made to resuscitate the patient.

Every time a physician admits an elderly or critically ill patient to a hospital, the question of CPR should be discussed. (See Chapter 13.) The hospital should let every patient know the CPR policies of the hospital and provide an opportunity for the patient to refuse such services. Far too many patients undergo one resuscitation only to request that it not be done again. Such decisions should not be left until the patient is unconscious, and there is no one with the legal right to authorize or refuse care.

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