Strictly speaking, do-not-resuscitate (DNR) orders mean only that CPR should not be performed for a cardiopulmonary arrest. Other treatment—such as antibiotics, transfusions, dialysis, and ventilator support—may still be given. More specific orders are required to indicate whether the person should be hospitalized or whether a patient should be treated in an intensive care unit.
To assist physicians in managing the care of patients for whom CPR may not be appropriate, the American Medical Association Council on Ethical and Judicial Affairs in 1991 issued the following guidelines.
1.    Efforts should be made to resuscitate patients who suffer cardiac
or respiratory arrest except when CPR would be futile or not in accor
dance with the desires or best interests of the patient.
2.    Physicians should discuss the possibility of cardiopulmonary ar
rest with appropriate patients and encourage them to state whether
v wiiiil CPR. The discussions should include a description of CPR \ctltiirs and, when possible, should occur in an outpatient setting N< iin;il treatment preferences are discussed or as early as possi-IHMI lu’M'ilali/ation, when the patient is likely to be mentally vl» tli<u iiHsiuns before an emergency arises help ensure the pa-<?». iihtittiii HI the decision-making process. Subsequent periodic discussions can determine if the patient has changed his mind because his circumstances or the treatment alternatives have changed.
3.    If a patient is incapable of making a decision about CPR, the surro
gate may make it, based on the patient’s previously expressed prefer
ences or, if such preferences are unknown, in accordance with the pa
tient’s best interests.
4.    The physician has an ethical obligation to honor the resuscitation
preferences expressed by the patient or the surrogate. Physicians
should not allow their personal value judgments about quality of life to
affect the implementation of a patient’s or surrogate’s preferences re
garding the use of CPR. However, if in the physician’s judgment CPR
would be futile, the physician may enter a DNR order into the patient’s
record. If time permits, the physician must inform the patient or the
surrogate of the content of the DNR order and the basis for its imple
mentation. The physician also should be prepared to discuss appropri
ate alternatives, such as obtaining a second opinion or arranging for a
transfer of care to another physician.
5.    Resuscitative efforts should be considered futile only if they can
not be expected to restore cardiac or respiratory function or to achieve
the patient’s expressed goals.
6.    The DNR orders, as well as the basis for their implementation,
should be entered by the attending physician in the patient’s medical
record.
7.    The DNR orders preclude only resuscitation efforts in the event of
cardiopulmonary arrest, not other therapeutic interventions that are
appropriate for the patient.
8.    Hospital medical staffs should periodically review their experi
ence with DNR orders, revise their DNR policies as appropriate, and
inform physicians about their role in the decision-making process for
DNR orders.

For the last decade, scholars have discussed and institutions have experimented with policies governing special categories of care, especially resuscitation. Many hospitals—and with increasing frequency, long-term eare facilities—have policies to guide decisions about resuscitation. These policies vary widely; some reserve the decision for the physician, others empower patients and designated surrogates to make the decision. New YorkJState has legislated the patient’s right to decide on resuscitation status.
As with other decisions about care, decisions about resuscitation should be brought to patients’ attention when they are lucid. No matter who decides, some system should exist for recording, communicating, and reviewing the decision. No legal case has been reported in which a physician or an institution has been found liable for respecting a do-not-resuscitate order that was written after an appropriate discussion with the patient and family and was duly noted on the patient’s chart.