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January 16, 1991

Family Consent to Orders Not to Resuscitate

JAMA. 1991;265(3):354-355. doi:10.1001/jama.1991.03460030060016

To the Editor. —  After reading the articles by Tomlinson, Hackler, and associates,1,2 my response is a resounding "It's about time." I recently completed a 3-year fellowship in resuscitation research during which I attended more than 400 cardiac arrests. In most cases, the family acted in the reasonable best interest of the patient. However, there were more than a few cases in which the policies relating to DNR orders resulted in the infliction of unnecessary pain and bizarre allocation of limited resources.In most cases, the surrogate is not a single individual, but a family, each member of which may believe he or she has sole veto power over the decision not to resuscitate. The dynamic of these situations is that family members who believe that termination of aggressive therapy is in the best interest of the patient, even if in the majority, will accede to the request of