title: Do-not-resuscitate orders and medical futility.
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.
authors.affiliation: National Center for Ethics in Health Care of the Veterans Health Administration, Washington, DC 20420, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cantor
authors.forename: Clarence H
authors.initials: CH
authors.lastname: Braddock
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Derse
authors.forename: Denise Murray
authors.initials: DM
authors.lastname: Edwards
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Logue
authors.forename: William
authors.initials: W
authors.lastname: Nelson
authors.forename: Angela M
authors.initials: AM
authors.lastname: Prudhomme
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pearlman
authors.forename: James E
authors.initials: JE
authors.lastname: Reagan
authors.forename: Ginger Schafer
authors.initials: GS
authors.lastname: Wlody
authors.forename: Ellen
authors.initials: E
authors.lastname: Fox
mesh_terms: D016887:Cardiopulmonary Resuscitation; D017041:Ethics Committees; D006291:Health Policy; D006801:Humans; D018447:Medical Futility / Q000941:ethics / Q000331:legislation & jurisprudence; D016414:Resuscitation Orders / Q000941:ethics / Q000331:legislation & jurisprudence; D014481:United States; D014493:United States Department of Veterans Affairs