THE CARDIOPULMONARY RESUSCITATION-NOT-INDICATED ORDER - FUTILITY REVISITED

This paper reviews the advent of unilateral do-not-resuscitate orders. Unilateral do-not-resuscitate policies presume that cardiopulmonary r esuscitation is a medical therapy and that physicians have no obligati on to undertake a medical therapy that does not offer achievable and a ppropriate goals. Four do-not-resuscitate policies from U.S. hospitals and some of the significant published proposals are reviewed. We conc lude that anything other than a physiologic definition of futility is indefensible because of imposed value judgments, imprecise definitions of quantitative and qualitative futility, inexact data, lack of certi tude of economic benefit, and the role of autonomy for the patient and physician.