Faculty Collaboration Database

Do-not-resuscitate orders and medical futility. Arch Intern Med 2003 Dec 8-22;163(22):2689-94

Date

12/10/2003

Pubmed ID

14662622

DOI

10.1001/archinte.163.22.2689

Scopus ID

2-s2.0-0345168152 (requires institutional sign-in at Scopus site)   58 Citations

Abstract

This report addresses the difficult situation in which a patient or surrogate decision maker wishes cardiopulmonary resuscitation to be attempted even though the physician believes that resuscitation efforts would be futile. It also reviews current controversies surrounding the subject of do-not-resuscitate (DNR) orders and medical futility, discusses the complex medical, legal, and ethical considerations involved, and then offers recommendations as a guide to clinicians and ethics committees in resolving these difficult issues. Conflicts over DNR orders and medical futility should not be resolved through a policy that attempts to define futility in the abstract, but rather through a predefined and fair process that addresses specific cases and includes multiple safeguards. As it examines these issues, the report focuses on the Veterans Health Administration (VHA). Current national VHA policy constrains physicians from entering a DNR order over the objection of a patient or surrogate even if the physician believes cardiopulmonary resuscitation to be futile. The VHA National Ethics Committee recommends that VHA policy be changed to reflect the opinions expressed in this report. The National Ethics Committee, which is composed of VHA clinicians and leaders, as well as veterans advocates, creates reports that analyze ethical issues affecting the health and care of veterans treated in the VHA, the largest integrated health care system in the United States. This report does not change or modify VHA policy.

Author List

Cantor MD, Braddock CH 3rd, Derse AR, Edwards DM, Logue GL, Nelson W, Prudhomme AM, Pearlman RA, Reagan JE, Wlody GS, Fox E, Veterans Health Administration National Ethics Committee

Author

Arthur R. Derse MD, JD Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiopulmonary Resuscitation
Ethics Committees
Health Policy
Humans
Medical Futility
Resuscitation Orders
United States
United States Department of Veterans Affairs