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August 21, 1996, Vol 276, No. 7 >
ARTICLE | August 21, 1996

A Multi-institution Collaborative Policy on Medical Futility FREE

Amir Halevy, MD; Baruch A. Brody, PhD
[+] Author Affiliations

Reprints: Amir Halevy, MD, General Medicine Section, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030.


JAMA. 1996;276(7):571-574. doi:10.1001/jama.1996.03540070067035
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References

AN INFANT born with multiple congenital abnormalities that rendered survival unprecedented required high-dose vasopressors to maintain blood pressure. After several days, gangrene developed in the extremities, and the parents sequentially demanded amputations of several limbs in an attempt to "do everything." The surrogate decision maker for a comatose woman dying of multisystem organ failure in an intensive care unit (ICU) was her estranged husband; they separated because of repeated spousal abuse. Despite many conferences with the husband recommending comfort measures and a do-not-resuscitate order, the husband demanded that the medical staff "do everything to my wife." A public hospital serving an indigent community of several hundred thousand had a full ICU, and 3 patients were being kept in the emergency department on ventilators. One of the patients in the ICU was a gentleman who had been ventilator dependent and unresponsive for 41/2 months after a cardiac arrest; his daughter insisted

REFERENCES

1 +
Council on Ethical and Judicial Affairs, American Medical Association.  Guidelines for the appropriate use of do-not-resuscitate orders . JAMA . 1991;;265:1868-1871.
2 +
Ethics Committee.  American College of Physicians Ethics Manual . Ann Intern Med . 1992;;117:947-960.
3 +
American Thoracic Society.  Withholding and withdrawing life-sustaining therapy . Am Rev Respir Dis . 1991;;144:726-731.
4 +
Society of Critical Care Medicine, Task Force on Ethics.  Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill . Crit Care Med . 1990;;18:1435-1439.
5 +
Schneiderman LJ, Jecker NS, Jonsen AR.  Medical futility: its meaning and ethical implications . Ann Intern Med . 1990;;112:949-954.
6 +
The Hastings Center. Guidelines on the Termination of Life-sustaining Treatment and the Care of the Dying . Bloomington: Indiana University Press; 1987;.
7 +
Grant ER.  Medical futility: legal and ethical aspects . Law Med Health Care . 1992;;20:330-335.
8 +
Daar JF.  Medical futility and implications for physician autonomy . Am J Law Med . 1995;;21:221-240.
9 +
Sadler JZ, Mayo TW.  The Parkland approach to demands for 'futile' treatment . HEC Forum . 1993;;5:35-38.
10 +
Santa Monica Hospital Medical Center.  Futile care guidelines . Med Ethics Advisor . 1993;;( (Octover suppl) ):9.
11 +
Waisel DB, Truog RD.  The cardiopulmonary resuscitation-not-indicated order: futility revisited . Ann Intern Med . 1995;;122:304-308.
12 +
Brody BA, Halevy A.  Is futility a futile concept? J Med Philos . 1995;;20:123-144.
13 +
Halevy A, Neal RC, Brody BA.  The low frequency of futility in an adult intensive care unit setting . Arch Intern Med . 1996;;156:100-104.
14 +
Sachdeva R, Jefferson L, Coss-Bu J, Brody B.  Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting . J Pediatr . 1996;;128:742-747.
15 +
Gewirtz P.  On 'I know it when I see it.' Yale Law J . 1996;;105:1023-1047.
16 +
Council on Ethical and Judicial Affairs, American Medical Association. Code of Medical Ethics . Chicago, Ill: American Medical Association; 1994;.
17 +
Murphy DJ, Barbour E.  GUIDe (Guidelines for the Use of Intensive Care in Denver): a community effort to define futile and inappropriate care . New Horizons . 1994;;2:326-331.
18 +
Truog RD, Brett AS, Frader J.  The problem with futility . N Engl J Med . 1992;;326:1560-1564.
19 +
Tomlinson T, Brody H.  Futility and the ethics of resuscitation . JAMA . 1990;;264:1276-1280.
20 +
Tomlinson T, Czlonka D.  Futility and hospital policy . Hastings Cent Rep . 1995;;25:28-35.
21 +
Jecker NS, Schneiderman LJ.  Futility and rationing . Am J Med . 1992;;92:189-196.
22 +
In the matter of Baby K, 16 F3d 590 (4th Cir, 1994).

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Council on Ethical and Judicial Affairs, American Medical Association.  Guidelines for the appropriate use of do-not-resuscitate orders . JAMA . 1991;;265:1868-1871.
2 +
Ethics Committee.  American College of Physicians Ethics Manual . Ann Intern Med . 1992;;117:947-960.
3 +
American Thoracic Society.  Withholding and withdrawing life-sustaining therapy . Am Rev Respir Dis . 1991;;144:726-731.
4 +
Society of Critical Care Medicine, Task Force on Ethics.  Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill . Crit Care Med . 1990;;18:1435-1439.
5 +
Schneiderman LJ, Jecker NS, Jonsen AR.  Medical futility: its meaning and ethical implications . Ann Intern Med . 1990;;112:949-954.
6 +
The Hastings Center. Guidelines on the Termination of Life-sustaining Treatment and the Care of the Dying . Bloomington: Indiana University Press; 1987;.
7 +
Grant ER.  Medical futility: legal and ethical aspects . Law Med Health Care . 1992;;20:330-335.
8 +
Daar JF.  Medical futility and implications for physician autonomy . Am J Law Med . 1995;;21:221-240.
9 +
Sadler JZ, Mayo TW.  The Parkland approach to demands for 'futile' treatment . HEC Forum . 1993;;5:35-38.
10 +
Santa Monica Hospital Medical Center.  Futile care guidelines . Med Ethics Advisor . 1993;;( (Octover suppl) ):9.
11 +
Waisel DB, Truog RD.  The cardiopulmonary resuscitation-not-indicated order: futility revisited . Ann Intern Med . 1995;;122:304-308.
12 +
Brody BA, Halevy A.  Is futility a futile concept? J Med Philos . 1995;;20:123-144.
13 +
Halevy A, Neal RC, Brody BA.  The low frequency of futility in an adult intensive care unit setting . Arch Intern Med . 1996;;156:100-104.
14 +
Sachdeva R, Jefferson L, Coss-Bu J, Brody B.  Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting . J Pediatr . 1996;;128:742-747.
15 +
Gewirtz P.  On 'I know it when I see it.' Yale Law J . 1996;;105:1023-1047.
16 +
Council on Ethical and Judicial Affairs, American Medical Association. Code of Medical Ethics . Chicago, Ill: American Medical Association; 1994;.
17 +
Murphy DJ, Barbour E.  GUIDe (Guidelines for the Use of Intensive Care in Denver): a community effort to define futile and inappropriate care . New Horizons . 1994;;2:326-331.
18 +
Truog RD, Brett AS, Frader J.  The problem with futility . N Engl J Med . 1992;;326:1560-1564.
19 +
Tomlinson T, Brody H.  Futility and the ethics of resuscitation . JAMA . 1990;;264:1276-1280.
20 +
Tomlinson T, Czlonka D.  Futility and hospital policy . Hastings Cent Rep . 1995;;25:28-35.
21 +
Jecker NS, Schneiderman LJ.  Futility and rationing . Am J Med . 1992;;92:189-196.
22 +
In the matter of Baby K, 16 F3d 590 (4th Cir, 1994).

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