Use of the medical futility rationale in do-not-attempt-resuscitation orders
Article Abstract:
Resident physicians do not seem to use the medical futility rationale to avoid discussing end-of-life issues with patients, although residents may inconsistently apply the concepts of quantitative and qualitative futility. Medical futility is a justification for do-not-attempt-resuscitation (DNAR) orders in patients who have very low odds of survival and those who would have an unacceptably poor quality of life after resuscitation. Researchers interviewed 44 internal medicine residents about the residents' use of DNAR orders in 145 hospitalized patients. Medical futility applied to 91 DNAR orders and was the sole reason for the order in 17 cases. Medical residents discussed the DNAR orders with all patients who could communicate for whom the medical futility rationale was invoked. In 24 of the 75 cases of quantitative futility, residents estimated the patients' probability of survival at 5% or more. In 14 of the 40 cases in which qualitative futility was applied to communicative patients, residents determined qualitative futility without seeking patient input.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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Integrating palliative care for liver transplant candidates: "Too well for transplant, too sick for life"
Article Abstract:
Patients with end-stage liver disease are often beset by wide-ranging and distressing symptoms that markedly decrease their quality of life, despite treatment advances, and hence they should be helped to understand that they might not be eligible for orthotopic liver transplantation (OLT), might die while awaiting OLT, or might die following OLT. Early discussions of advance care planning and end-of-life care issues while simultaneously providing support for hopes of a successful transplant are important components of high-quality care for these patients.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2006
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Caring for the dying in the intensive care unit: in search of clarity
Article Abstract:
A study published in 2003 showed that there is great variability in Europe in how critically ill patients in intensive care units are treated. This could reflect cultural and religious differences between European countries. Doctors can still develop standards for critical care that are effective but still sensitive to cultural differences.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 2003
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