RT Journal
A1 Murphy DJ
T1 IN-hospital cardiopulmonary resuscitation-reply
JF JAMA
JO JAMA
YR 1989
FD March 17
VO 261
IS 11
SP 1582
OP 1582
DO 10.1001/jama.1989.03420110053015
UL http://dx.doi.org/10.1001/jama.1989.03420110053015
AB In Reply.— 
    I agree with Drs Blackhall, Brody, and Tomlinson. We should discuss advance directives, including CPR, with our patients and their families. The question I raise is whether we must discuss CPR before writing a DNR order for severely demented patients or patients for whom CPR is futile.The policy I propose should not imply that we curtail communication with patients and families. Simply writing a DNR order does not excuse the physician from discussing life-sustaining therapies (feeding tubes, intravenous antibiotics, emergency surgery, and so on) that can profoundly alter the last months or years of our patients' lives. When these issues are addressed, a discussion of CPR will follow.Dr Blackhall suggests that the decision to withhold CPR because of poor quality of life can be made only by patients and their families. In most cases, I agree. But what about the severely demented patient, bedbound with decubitus