Limits to Life-Sustaining Treatment
4. Caregiver(s) and/or institution
Unilateral DNR (Do Not Resuscitate) orders are not uncommon - despite the expectation by accrediting agencies that these decisions will be discussed with the patient and/or proxies.
Institutional policies may also determine decisions - even in a state that permitted physician-assisted suicide, for example, Catholic hospitals would probably be permitted to refuse to allow it to be carried out in their institution.
Most health care institutions have policies about the procedure to establish DNR status for a patient, as well as other forms of limiting treatment whether at the patient's request (through an advance directive, for example) or at the initiative of the health professional.
Institutional policies and caregiver attitudes about hospice referral may have consequences for limits to treatment (either facilitating them or making them more difficult).
Mny hospitals have recently enacted policies regarding "futile" care - which set out a procedure by which caregivers can refuse to provide measures that patient/families/proxies might request.