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December 1985

Is 'Futility' a Prerequisite to a 'Do Not Resuscitate' Decision?-Reply

Author Affiliations

San Francisco

Arch Intern Med. 1985;145(12):2268. doi:10.1001/archinte.1985.00360120138035

In Reply.  —Dr Foley correctly points out that a DNR order applies only to cardiopulmonary resuscitation. Decisions about other care need to be made separately. In cases 5 and 6 in our article, physicians justified unilateral DNR orders, as well as withholding transfer to the intensive care unit, because of medical futility. We suggest that ambiguous terms like futile may be misleading and question whether the particular assessments of futility in these cases were correct. The DNR orders by physicians against the explicit wishes of the competent patient or the family of an incompetent patient may not be appropriate. The President's Commission rejects such unilateral decisions by physicians and advises reassessment by both parties.1 Transfer of care to another provider and asking the courts to decide are ethically acceptable procedures, but may not be practical. Elsewhere we have suggested that unilateral DNR orders by physicians are appropriate only in

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