Implementing A “Do‐Not‐Resuscitate” (DNR) Policy in a Nursing Home

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Abstract
During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (meange .+-. SD = 76.4 .+-. 12.1 years) chose DNR; 30 patients with capacity (mean age .+-. SD = 76.2 .+-. 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age .+-. SD = 86.1 .+-. 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age .+-. SD = 81.9 .+-. 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.