'No resuscitation' orders: perspectives, policies, problems and procedures.

Chedoke-McMaster Hospitals in Hamilton have evolved a 'No CPR' Policy for over seven years. This article describes some of the important ethical, administrative and practical clinical factors in successful application of a 'No CPR' order to the management of terminally ill patients. The role of the attending physician is critical in negotiating 'No CPR' decisions with patients and families. Physicians' attitudes toward death and their perceptions of their professional responsibilities for patients determine if and how an order will be written. Several clinical strategies are suggested to help negotiate a 'no CPR' decision.