To the Editor.
—The multi-institution collaborative policy on medical utility developed by the Houston Bioethics Network1 is an impressive achievement given the controversy surrounding this subject. The Medical Society of New Jersey, which represents approximately 9500 physicians, has, through its biomedical ethics committee, been struggling over the past 2 years with this same issue and will soon publish a model policy and procedure for New Jersey physicians and hospitals to use as a guideline.2Remarkable similarities exist between the 2 policies. Just as our Houston colleagues decided that process is more important than a stringent definition of futility, so too we emphasize communication, negotiation, second opinions, ancillary support persons, and ethics committee review. We believe that futility decisions must result from a shared decisionmaking process between the physician and the patient or the patient's surrogate wherein the physician supplies the objective data about the effectiveness of the proposed