In-Hospital Cardiopulmonary Resuscitation

To the Editor. —  The articles by Taffet et al¹ and Murphy² in the October 14 issue of JAMA are important contributions to our understanding of the use of cardiopulmonary resuscitation (CPR) and donot-resuscitate orders; however, they raise several important issues that need clarification before we can decide under what circumstances, if any, do-not-resuscitate orders can be issued on purely medical grounds. The first is, as Youngner³ suggests, the definition of futility with respect to CPR. The second is whether the decision to withhold CPR on the basis of futility frees us of the responsibility of talking to our patients and their families about their care.I disagree with Youngner's assertion³ that it is impossible to define futility with respect to CPR. In a case like metastatic cancer, where study after study has shown no survival until discharge, the designation "futile" is realistic.^1,4 Although some patients