Inadequate Documentation of Unilateral Do-Not-Resuscitate Orders

In a recent JAMA Viewpoint, Gina M. Piscitello and colleagues criticize "Inadequate Documentation of Unilateral Do-Not-Resuscitate Orders."  

A DNR order in the patient's chart should reflect whether (1) it was written with patient/surrogate consent or (2) it was written unilaterally.

For decades much discussion has focused on whether and when clinicians can write DNR orders without consent (unilateral DNR orders). Piscitello focus on the transparency of the process.

This is easy with Vermont and Maryland POLST forms which have separate checkboxes for consent and futility. But it is important elsewhere because litigation experience with unilateral withholding and withdrawing of life-sustaining treatment shows that liability risks are higher when the process is either secretive or insensitive.