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Medline ® Abstracts for References 4,5

of 'Palliative care: Medically futile and potentially inappropriate therapies of questionable benefit'

4
TI
Epidemiology of no-code orders in an academic hospital.
AU
Uhlmann RF, McDonald WJ, Inui TS
SO
West J Med. 1984 Jan;140(1):114-6.
 
Relatively little is known about the circumstances in which decisions not to resuscitate, documented by no-code orders, are made. By review of medical records and interviews with house staff officers, we studied all medical service patients for whom no-code orders were written and those patients who received cardiopulmonary resuscitation (CPR) between October and December 1980 in the Portland Veterans Administration Medical Center. Among 1,780 patients admitted, 56 (3.1%) received no-code orders. All decisions were reportedly made by groups of individuals usually including the intern (98% of cases) and resident (93%), but not attending physician (39%). Many patients (43%) were disoriented or obtunded at the time of the no-code decision and 80% of oriented patients did participate in the decision.Thirty-seven of the 56 no-code patients died during the study. Comparing these with 20 patients who experienced cardiac arrest and did receive CPR, cancer, dementia, incontinence, non-ambulatory, divorced-separated and unemployed statuses were all more prevalent among no-code patients (P<.05).No-code orders in this Veterans Administration teaching hospital were relatively common and appeared to be made collectively. Participation of patients and attending physicians in the decisions, however, was limited.
AD
PMID
5
TI
Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law.
AU
Pope TM
SO
J Law Med Ethics. 2017;45(1):12.
 
The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.
AD
Thaddeus Mason Pope, J.D., Ph.D., is the Director of the Health Law Institute and a Professor at Mitchell Hamline School of Law.
PMID