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In Reply. —The letter of Stewart and Rai can be read as a powerful testimony to the pervasiveness of potentially dangerous assumptions regarding the implications of a patient's "DNR status" that occur when these decisions are made "less formal[ly]"; by "junior medical staff"; "rarely discussed with patients or their relatives"; and when "communication... to nursing staff and discussion surrounding the reasons for reaching these decisions may be [is] inadequate." The solution does not lie in adoption of another category such as "comfort measures only," but rather, in explicit acknowledgment of the fact that this is a problem of our own creation; that cardiopulmonary resuscitation is rarely of predictable benefit to patients sick enough to be hospitalized; and that we have the responsibility of initiating and sustaining an open and honest dialogue with patients, families, and staff, particularly when admitting patients to settings in which they will be "at risk" unless
BARTHOLOME WG. Do Not Resuscitate Orders-Reply. Arch Intern Med. 1990;150(5):1125. doi:10.1001/archinte.1990.00390170147040