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July 26, 1995

DNR Orders and Medical Futility

Author Affiliations

Michigan State University East Lansing
Sinai Hospital of Detroit Detroit, Mich

JAMA. 1995;274(4):299. doi:10.1001/jama.1995.03530040025020

To the Editor.  —The article by Dr Curtis and colleagues1 on the use of the medical futility rationale for do-not-attempt-resuscitation (DNAR) orders and the accompanying Editorial by Ms Alpers and Dr Lo2 offer fewer reasons for concern about the use of futility than they suppose.First of all, the analysis by Curtis and colleagues on the use of quantitative futility is contaminated by the fact that of the 75 patients whose DNAR orders were in part supported by an appeal to quantitative futility, 45 (60%) also involved appeals to qualitative futility, and the great majority were in part determined by patient or family choice as well. Thus, the finding that a third of the patients to whom quantitative futility was applied were given probabilities of survival to discharge of greater than 5% tells us nothing about what likelihood of survival the residents thought would warrant a DNAR order

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