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

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 (mean age ± 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. 1989 The American Geriatrics Society