The Do-Not-Resuscitate Order as Ritual

Abstract

I should acknowledge from the start a certain skepticism, not only about the New York State Do-Not-Resuscitate (DNR) law but about DNR orders more generally. As contributors to this volume also suggest, I want to argue that if we think of DNR orders as decisions or of the new state law as a means of enforcing a certain type of decision-making process, we will not get very far. I am sceptical about the law because of research I conducted in the ICUs of two large teaching hospitals, one in New York, the other in Massachusetts. While the research was conducted before the enactment of the DNR law, both insitutions had policies in place similar to the policies required by the law. My research suggests that DNR orders are not records decisions, but symbolic representations of decisions. The writing of a DNR order is, then, in language that I fear is more familiar to sociologists than to health care professionals, a type of ritual. I do not, however, invoke the notion of ritual in order to dismiss the new law. Quite to the contrary, I invoke the notion of ritual to suggest that the new law has made an important contribution to social change --- albeit one significantly different from that envisioned by the law itself.