I'm extremely disturbed by the suggestion that a do not resuscitate policy should be applied to people based on their demographic status rather than their individual health. "Likely low chance of success" is a consideration that needs to be applied to individuals, not social groups. Of course statistically speaking, elderly people in care homes are less likely to be successfully resuscitated. But that's like saying all children at a low-performing school should be automatically refused entry to Oxford or Cambridge because they're statistically less likely to get high exam results. Also, the default DNR policy being suggested is pretty hardline. While the authors seem to be suggesting there could be a right for patients to "opt in" to resuscitation rights, they aren't really - as the article makes quite clear, even if someone is capable of choosing resuscitation this could be refused on financial grounds. "Autonomy must be limited....by considerations of effectiveness and efficiency if treatment is funded through taxation." I agree that if we are cutting off the option to resuscitate because of the statistical possibility of success, this ought to be mooted as a national policy for all out of hospital arrests. (And why would it not apply to in hospital arrests as well?) Personally I don't think it is ethically acceptable to make this decision on other peoples' behalf for financial and statistical reasons, but even if this were reasonable then it would be unjustifiable discrimination to apply that calculation only to elderly people in nursing homes.