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January 16, 1991

Family Consent to Orders Not to Resuscitate-Reply

Author Affiliations

University of Arkansas Little Rock

University of Arkansas Little Rock

JAMA. 1991;265(3):355. doi:10.1001/jama.1991.03460030060018

In Reply.—  We thank Drs Steffen and Paradis for their letters supporting our recent article on hospital resuscitation policies. Dr Paradis agrees that policies requiring family agreement to DNR orders sometimes create serious problems for patients and families. He then goes beyond our arguments to considerations of equity or justice toward other patients. We believe that these concerns augment our case and are worthy of further discussion, but we also think that considerations of patient best interests and of the proper role of surrogates are sufficient to justify our proposal. We agree with Dr Steffen that a decision that CPR would be futile should not be based solely on the diagnosis but rather on a case-by-case review of all the medical evidence.Dr Doukas disagrees with our other proposal, that hospital policy not require that futile CPR always be discussed with patients or families. He points, as do Youngner1