Vanderbilt University Medical Center, Center for Biomedical Ethics and Society, 2525 West End Ave, Suite 400, Nashville, TN 37203, USA.
Am J Bioeth. 2010 Jan;10(1):61-7. doi: 10.1080/15265160903469328.
This paper examines the historical rise of both cardiopulmonary resuscitation (CPR) and the do-not-resuscitate (DNR) order and the wisdom of their continuing status in U.S. hospital practice and policy. The practice of universal presumed consent to CPR and the resulting DNR policy are the products of a particular time and were responses to particular problems. In order to keep the excesses of technology in check, the DNR policies emerged as a response to the in-hospital universal presumed consent to CPR. We live with this historical concretion, which seems to perpetuate a false culture that the patient's wishes must be followed. The authors are critical of the current U.S. climate, where CPR and DNR are viewed as two among a panoply of patient choices, and point to UK practice as an alternative. They conclude that physicians in the United States should radically rethink approaches to CPR and DNR.
本文考察了心肺复苏术（CPR）和“不复苏”（DNR）医嘱的历史兴起，以及它们在美国医院实践和政策中持续存在的合理性。普遍假定同意进行心肺复苏术和由此产生的 DNR 政策是特定时期的产物，是对特定问题的回应。为了控制技术的过度发展，DNR 政策的出现是对医院内普遍假定同意进行心肺复苏术的回应。我们生活在这种历史的凝固中，这种情况似乎使一种错误的文化永久化，即必须遵循患者的意愿。作者批评了目前美国的这种情况，即心肺复苏术和 DNR 被视为众多患者选择中的两种，同时指出英国的做法是一种替代选择。他们得出结论，美国的医生应该彻底重新思考心肺复苏术和 DNR 的方法。
