Does compassion for a family justify providing futile CPR?

Paris, Julien; Angelos, Peter; Schreiber, Michael D.

doi:10.1038/jp.2010.105

Cited by 14 publications

(7 citation statements)

References 18 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Of course, in some situations, that is unfortunately already the case. But if one accepts that chemotherapy or surgery with no benefit to the patient should not be done, or even offered, we see no compelling argument as to why CPR should be different.…”

Section: The Slippery Slopementioning

confidence: 99%

Unilateral Pediatric “Do Not Attempt Resuscitation” Orders: The Pros, the Cons, and a Proposed Approach

Mercurio

Murray²,

Gross³

2014

Pediatrics

View full text Add to dashboard Cite

A unilateral do not attempt resuscitation (DNAR) order is written by a physician without permission or assent from the patient or the patient' s surrogate decision-maker. Potential justifications for the use of DNAR orders in pediatrics include the belief that attempted resuscitation offers no benefit to the patient or that the burdens would far outweigh the potential benefits. Another consideration is the patient' s right to mercy, not to be made to undergo potentially painful interventions very unlikely to benefit the patient, and the physician' s parallel obligation not to perform such interventions. Unilateral DNAR orders might be motivated in part by the moral distress caregivers sometimes experience when feeling forced by parents to participate in interventions that they believe are useless or cruel. Furthermore, some physicians believe that making these decisions without parental approval could spare parents needless additional emotional pain or a sense of guilt from making such a decision, particularly when imminent death is unavoidable. There are, however, several risks inherent in unilateral DNAR orders, such as overestimating one' s ability to prognosticate or giving undue weight to the physician' s values over those of parents, particularly with regard to predicted disability and quality of life. The law on the question of unilateral DNAR varies among states, and readers are encouraged to learn the law where they practice. Arguments in favor of, and opposed to, the use of unilateral DNAR orders are presented. In some settings, particularly when death is imminent regardless of whether resuscitation is attempted, unilateral DNAR orders should be viewed as an ethically permissible approach. Pediatrics 2014;133:S37-S43

show abstract

Section: The Slippery Slopementioning

confidence: 99%

Unilateral Pediatric “Do Not Attempt Resuscitation” Orders: The Pros, the Cons, and a Proposed Approach

Mercurio

Murray²,

Gross³

2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…The AMA statement 23 specifically addresses medically futile treatment that nevertheless benefits patients in non‐clinical ways, but does not make the same case for treatment that benefits family members. Truog 27 has argued that it may sometimes be ethically appropriate to provide such care, but there are questions about how far treatment, particularly where it is burdensome, should be continued to benefit someone other than the patient 28 . However, we note that patient needs and family needs may overlap, 29 and ensuring that the family are in broad agreement with treatment decisions is often considered good clinical practice.…”

Section: Methodsmentioning

confidence: 96%

“…Truog 27 has argued that it may sometimes be ethically appropriate to provide such care, but there are questions about how far treatment, particularly where it is burdensome, should be continued to benefit someone other than the patient. 28 However, we note that patient needs and family needs may overlap, 29 and ensuring that the family are in broad agreement with treatment decisions is often considered good clinical practice. For example, further treatment that allows preparation for death, including time for relatives to gather, may well be acceptable and appreciated by the patient.…”

Section: E3mentioning

confidence: 99%

What does “futility” mean? An empirical study of doctors' perceptions

White

Willmott

et al. 2016

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…They are more meaningful because they translate complex medical therapies and interventions into explicit, practical, and relevant concepts and goals for patients and families (Feudtner 2007;Klick and Hauer 2010). Additionally, families are no longer forced to make nearly impossible choices between doing 'everything' (perform CPR) or giving up (consent to DNR) (Blackhall 1987;Paris, Angelos, and Schreiber 2010). Finally, they help preserve the integrity of physicians by allowing medical knowledge and expertise to guide end-of-life treatment decisions while simultaneously enabling doctors to be explicit regarding the limitations of medicine (Blackhall 1987).…”

mentioning

confidence: 97%