In this issue, Feder and colleagues report on guidelines in King County, Washington, that allowed emergency medical services (EMS) personnel to withhold resuscitation from a terminally ill patient if a family member or caregiver at the scene verbally reported that the patient did not want it. In the 16 EMS agencies that adopted the guidelines, EMS personnel withheld resuscitation nearly twice as often (5.9% before using the guidelines vs. 11.8% after using them), mostly because of honoring verbal requests. The guidelines raise some practical concerns but offer an alternative to the always resuscitate approach.
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