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January 16, 1991

Family Consent to Orders Not to Resuscitate

JAMA. 1991;265(3):354. doi:10.1001/jama.1991.03460030060015

To the Editor.—  Two recent articles1,2 argue that when a physician determines that cardiopulmonary resuscitation (CPR) would be futile, then the physician should be allowed to write the "do not resuscitate" (DNR) order without permission from the competent patient or the incompetent patient's surrogate. In the first article, Hackler and Hiller addressed the hospital policy that requires this permission and argued that not only when CPR is determined to be futile but also when the physician believes that the burdens of CPR clearly outweigh the benefits, the physician should be allowed to write the DNR order without the surrogate's permission.I agree with Hackler and Hiller and have argued3 that treatment goals are legitimate if, among other things, they are empirically possible and ethically justified. In the two cases that Hackler and Hiller describe, the surrogates' treatment goals, presumably successful resuscitation, were not legitimate. In both cases, resuscitation