Unanswered Questions About DNR Orders

Bernard Lo, MD
JAMA. 1991;265(14):1874-1875. doi:10.1001/jama.1991.03460140102036.
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Everyone who dies suffers a cardiac arrest. Cardiopulmonary resuscitation (CPR) can revive patients after they experience unexpected cardiac arrests and restore them to vigorous health. But for persons with progressive chronic illness, CPR is more likely to prolong death than prevent it. The thoughtful guidelines promulgated by the American Medical Association (AMA) concerning do-not-resuscitate (DNR) orders1 deserve careful reading by all physicians, but they do not address several important questions. Furthermore, on some issues, reasonable physicians will disagree, perhaps intensely.

When Is CPR Futile?  It is irrational to provide CPR when it would be futile. But while this general rule seems obvious, it may be difficult to decide, in particular cases, whether CPR would be "futile." The term futile is used in many different ways.2 In a strict sense, treatment is futile when it offers no benefit to the patient, because maximal therapy has failed and physiologic improvement is


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