Do-not-resuscitate orders: a critical review of the literature.

Formal DNR policies have improved the process by which decisions to withhold CPR are made. Slow and sham codes are now rare. Communication between physicians and patients and between physicians and providers of in-hospital CPR clearly exceeds that in other developed countries. Results of early studies that examined the care received by those with and without advance directives have been unable to document differences. A more realistic appraisal of the potential role for advance directives coupled with an emphasis on education and rational treatment guidelines should promote continued improvement in the compassionate use of cardiopulmonary resuscitation.