DNR, Do Not Resuscitate 1991 – The Right Not to Be Resuscitated

The civil rights leader Martin Luther King Jr. once said: 

“What matters in a person's life is its quality, not its length.”

For many years, there has been profound debate over when a physician should be permitted to end the life of a terminally ill or comatose patient. Law professor William A. Woodruff writes: 

“Medical technology has advanced to the point where a patient's vital signs can be maintained almost indefinitely, leading society to question the value of these advances. If a patient is permanently comatose, unable to interact with the environment... and unable to function even at a basic cognitive level, what purpose does keeping that person alive serve?”

Such questions led to the creation of modern do not resuscitate (Do Not Resuscitate – DNR) orders in the United States and other countries. These legal documents allow patients (or staff) to be informed that no attempt should be made to resuscitate a person if their heart or breathing stops.

An important step regarding DNRs in the United States was a legal case before the New Jersey Supreme  Court in 1975, in which the court approved her father's request to remove the comatose Karen Quinlan from artificial ventilation.

In 1991, the United States Patient Self-Determination Act required hospitals to respect patients' healthcare decisions, and competent patients gained the right to refuse treatment. Thus, advanced cardiac life support and cardiopulmonary resuscitation would not be used for patients with DNR orders.

Of course, DNRs have introduced certain complexities into healthcare. For example, with their introduction, a patient resuscitated in a hospital against their wishes may bring a “wrongful life” lawsuit. In the contrasting case of Payne v. Marion General Hospital (1990), the court found that the patient had been competent a few minutes before death and should therefore have been consulted. It consequently ruled against the physician who had issued a DNR order at the family's request. 

Historical Figure Mentioned in the Article: Karen Ann Quinlan (1954–1985)

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