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July 26, 1995

DNR Orders and Medical Futility

Author Affiliations

University of Rochester Rochester, NY

JAMA. 1995;274(4):299. doi:10.1001/jama.1995.03530040025019

To the Editor.  —It is not surprising that residents should have poor skills in areas where they have received no training. Studies on the delivery of bad news, obtaining informed consent, taking a sexual history, discussing end-of-life issues, and now of determining futility indicate that many of these tasks are performed poorly.1 All require high-order communication skills, emotional maturity, capacity for accurate empathy, and time. These skills are difficult to cultivate and require practice, experience, and active critique.If these complex skills are important, employed often, and involve major life-and-death decisions, why is there so little time in medical education devoted to the cultivation of advanced communication skills? In addition to developing ethical arguments for criteria for medical futility, we must train students and residents in these communication skills. Otherwise, abstract reasoning will take the place of care that respects the values of the person who is receiving it.

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