Abstract

KIE: Youngner responds to D.J. Murphy's article in this issue of JAMA in which Murphy advocates unilateral decision making by physicians concerning do-not-resuscitate (DNR) orders for some aged, chronically ill patients in long-term care (LTC) facilities. Youngner takes issue with Murphy's arguments for unilateral decision making, which involve the physician's assessment of the futility of treatment, the paternalistic desire to spare the patient and family members, and the need to reallocate medical resources. While agreeing with Murphy that CPR is contraindicated in many LTC patients, Youngner rejects his proposal to exclude patients and family members from the decision making process, and to not inform them of the physician's unilateral DNR decision. Youngner, a physician as is Murphy, warns that doctors must not substitute their values for those of their patients "under the guise of medical expertise and concern for resource allocation."