. "Limiting Life-Prolonging Medical Treatment: A Comparative Analysis of the President's Commission and the New York State Task Force." Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press, 1995.
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Society's Choices: Social and Ethical Decision Making in Biomedicine
What was the content of the reports? Do they incorporate the current consensus outlined above? Do they go beyond that consensus in valuable ways? The answer to these three crucial questions requires a careful analysis of the three reports.
The initial report on DNR orders provided for a presumption for the use of cardiopulmonary resuscitation (CPR) unless the patient or the surrogate consents to the issuance of a DNR order. The report made it clear (pp. 9-12) that this approach is grounded in the value of self-determination and that refusals of CPR should therefore be honored even when the patient does not have a terminal illness (this was one of the items that was dissented from by Rabbi Bleich, a member of the Task Force associated with the Orthodox Jewish community). In these ways, the report accepted principle (a) of the current consensus. By providing for DNR orders for both competent and incompetent patients, the report accepted principle (b) of the current consensus. Although it did provide for judicial review under certain circumstances (pp. 87-8), the report's main emphasis was on decision making outside the judicial system, so it accepted principle (c) of the current consensus. By calling for legislation and for institutional policies and dispute mediation systems (pp. 49-51), the report accepted principle (d) of the current consensus. Principles (e) and (f) were irrelevant to the report's discussion, which was confined to DNR orders because of the immediate needs in New York in light of the factors noted above. The report allowed both for patients indicating in advance that they do not want CPR and for their appointing surrogates to make that decision for them. It also rejected the opinion of the Court of Appeals, at least for the case of CPR (the only therapy it covered), in that it allowed (pp. 43-4) surrogates to use the substituted judgment and/or the best interests standard. Therefore, the report accepted principles (g) and (h) of the current consensus. Finally, the report accepted (pp. 46-9) parental decision making for minor children, thereby incorporating principle (i) of the current consensus.
There were some additional components of the report that went beyond the current consensus and should be noted. To begin with, it dealt with the problem of patients who have no surrogate decision maker, allowing for the writing of a DNR order when resuscitation would be futile (defined by the legislature35 as "CPR will be unsuccessful in restoring cardiac and respiratory function or that the patient will experience repeated arrest in a short time period before death occurs") or when a court directed that such an order be written (the legislature made it clear that the court could do so using either a substituted judgment or a best interest standard). Secondly, it addressed the issue, raised by the President's Commission, of limitations on surrogate decision making to refuse CPR. The Task Force (pp. 41-3) limited this authority to cases where the patient has