To the Editor.—
Although our article1 was cited by all four authors who discussed do-not-resuscitate (DNR) orders in a recent issue of JAMA,2-5 a critical distinction was missed that might have clarified the apparent disagreement between Murphy2 and Youngner.3 The former called for unilateral DNR decisions by the physician when resuscitation is demonstrably futile; the latter accused the former of unacceptable paternalism in excluding patient or family participation in DNR discussions.The distinction missing from this debate is that between the physician's decision whether resuscitation should be offered and the decision whether resuscitation should be discussed. As we explained in our article, when resuscitation is futile and offers nothing of benefit to the patient, it need not be offered as a matter of choice since it serves neither the patient's interests nor his rights. In this case, the decision against resuscitation is a matter of the
Brody H, Tomlinson T. In-Hospital Cardiopulmonary Resuscitation. JAMA. 1989;261(11):1581. doi:10.1001/jama.1989.03420110053013
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