Futility and the Ethics of Resuscitation

TLDR

Recent recommendations permitting physicians to withhold CPR without patient consent for futile cases have been criticized for undermining patient autonomy, based on the assumption that futility judgments require patient input. The authors argue that physicians must sometimes make unilateral value judgments about futility as part of reasonable medical practice. They contend that requiring patient consent to withhold futile therapy creates mixed messages that undermine autonomous choice, and that public dialogue on medical reasonableness and futility better serves patient interests. JAMA 1990;264:1276-1280.

Abstract

Recent recommendations that physicians be allowed to withhold cardiopulmonary resuscitation, without patient consent, from patients for whom it would be futile have drawn objections that such unilateral judgments would undermine respect for patient autonomy. These objections assume that since futility determinations involve value judgments, patient input is always required. However, certain sorts of value judgments must be made unilaterally by physicians as part of reasonable medical practice. Moreover, the mixed messages inherent in requesting patient consent to withhold futile therapy serve to undermine rather than to enhance autonomous choice. Real patient interests can better be served by a broad public dialogue around judgments of medical reasonableness and medical futility, rather than concern for the form but not the substance of patient autonomy. (<i>JAMA</i>. 1990;264:1276-1280)