Getting the DNR vs. Reaching Consensus

Wynne Ellen Morrison at The Children's Hospital of Philadelphia has a brief "personal reflection" piece in the Journal of Palliative Medicine titled "Is that All You Got?"  A young child is imminently dying from leukemia related complications such as overwhelming sepsis.  The ICU team is constantly pushing medications, fluids, and blood products.  The boy is on a ventilator.  Morrison then talks to the family and they all agree to make the patient DNR.  The fellow back in the ICU asks "is that all you got?"  





In her article, Morrison talks about framing the discussion as goal-oriented, as "getting the DNR."  She supports an "informed nondissent position" in which she makes her recommendation clear but allows the surrogates to raise objections.  Still, her overall purpose is not to "convince them they had to stop but to come to an agreement with them about mutually acceptable and achievable goals."  (HT: Art Caplan)