Medical Staff House Staff Orientation Manual - Montefiore Medical ...

• family has moral or religious objections to brain death definition or determination.
• clinical staff has conscientious objection to brain death definition or determination.
CONTACT:
Neurology 718- 920-6444
Neurosurgery 718- 920-4196
Medical Director 718- 920-7052; 6078
DO-NOT-RESUSCITATE (DNR) ORDERS
Summary - Administrative Policy and Procedure # JA11.1
Note: This summary contains the key points of this policy. For a complete understanding of all
the relevant provisions, it is necessary to thoroughly read the full policy.
WHAT:
A do-not-resuscitate (DNR) order is a consent to forego all or part of cardiopulmonary
resuscitation in the event of a cardiac and/or respiratory arrest. A DNR order does not affect or
limit any other care and can be consistent with aggressive treatment. In a cardiac and/or
pulmonary arrest, a DNR order permits withholding both intubation and other components of
CPR.
NOTE: Do-not-intubate (DNI) orders are distinct from DNR orders. In a cardio-pulmonary
arrest, a separate DNI order is not needed. Refer to Policy JDO5.1 for complete information on
DNI orders.
WHO:
• Suitable patients for DNR orders are those who are unlikely to survive or benefit from
resuscitation in the event of a cardiopulmonary arrest.
• Suitable patients with capacity should be approached for consent to a DNR order.
• Suitable patients without capacity should have consent to a DNR order given either by an
appointed health care agent or a DNR surrogate (see list of authorized surrogates) based on
one of the four specified medical conditions (see below).
• The patient’s attending physician determines suitability and decisional capacity, obtains
consent and writes the DNR order and notifies the patient or surrogate that the order has been
written.
• A determination by the attending that the patient lacks capacity must be confirmed by a
second attending. The second attending also concurs that an incapacitated patient without a
health care agent meets one of the four specified medical conditions (see below).
• House staff may obtain consent and enter a temporary DNR order after discussion with the
attending, who should countersign the order or enter a standing order on CIS within 24 hours.
• Medical director or designee must review, document and sign a DNR order based on medical
futility for patients who meet one of the two specified criteria, have no advance directives or
known wishes, no willing/available surrogate, and no family objecting to a DNR order.
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