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Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. "Code/no code" medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients' preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want. [ABSTRACT FROM AUTHOR]

An editorial is presented on the differences in the definition of brain death and their legal impact on intensive care practice. It expresses the view that adopting the definition of the particular medical condition by the international public health agency World Health Organization is likely to reduce the incidence of legal challenge and maintain public confidence in current death declaration practice internationally.

Discusses the so-called Baby Doe regulations promulgated during the Reagan administration which stipulate that the provider has no obligation to honor parental instructions to continue treatment when the treating physician believes that treatment is virtually futile and inhumane. Review of a case involving Sacred Heart Hospital in Spokane, Wash. and Ryan Nguyen who was born six weeks premature on October 27, 1994.