Conditional Permission to Not Resuscitate: A Middle Ground for Resuscitation.

Every decision to perform or withhold cardiopulmonary resuscitation (CPR) has ethical implications that are not always well understood. Value-based decisions with far-reaching consequences are made rapidly, based on incomplete or possibly inaccurate information. For some patients, skilled, timely CPR can restore spontaneous circulation, but for others, success may either be unobtainable or bring serious iatrogenic consequences. Because CPR is an aggressive process yielding mixed results, patients must be informed about the likelihood of its positive and adverse outcomes. In considering whether to accept or refuse it, patients should also be given a realistic set of alternatives. Current protocols limit patients\u27 options by restricting them to a choice between accepting or refusing CPR. Adding a middle code, DNAR-X (Do Not Attempt Resuscitation-Except), significantly expands patients\u27 right to control what happens to their bodies by allowing them to stipulate CPR in some circumstances but not in others