As general counsel to one of the largest hospitals in the United States, I want to discuss a topic which affects 15 to 20 patients in our hospital every day, those on whom physicians have written what we call “DNR” orders (Do Not Resuscitate). Any large tertiary care hospital has to deal regularly with this problem with respect to patients who are terminally ill and how to treat such patients in a wide variety of circumstances. What are the physician's and the hospital's obligations to provide Care?

On November 28,1977, the Massachusetts Supreme Judicial Court handed down its opinion in a case that has caused tremendous repercussions in hospitals throughout the country regarding the withholding or withdrawal of life-support to terminally ill patients. At the time this opinion was handed down, the decisions of physicians and hospitals on what to do with respect to withdrawing such care were based primarily on one of four models.

As Lee Dunn points out in his accompanying article, the Saikewicz case has been widely misunderstood and misinterpreted by health care providers both in Massachusetts and elsewhere. Two Massachusetts Appeals Court cases, Dinnerstein and Lone v. Canduru, have clarified some of the more controversial aspects of Suikewicz and should allay some of the fears which that case produced. The more important of the two decisions — Dinnerstein — involved the legality of “do not resuscitate” orders (DNR's) in the absence of a court order.

Mrs. Dinnerstein was diagnosed as suffering from Alzheimer's disease in July of 1975, although she probably had been afflicted with the disease since 1972. Alzheimer's disease is a progressive, unremitting disease of the brain which leads to disorientation, memory loss, loss of intellectual function, and, eventually, loss of all motor function. The usual course of the disease is five to seven years during which time the patient generally becomes a complete invalid and has to be institutionalized.