Medical futility and 'Do Not Attempt Resuscitation' orders

Abstract

Decisions about whether to attempt cardiopulmonary resuscitation (CPR) on an individual patient in a hospital or other health care setting often raise ethical dilemmas for members of the health care team. They are also of vital interest to many patients, and their relatives, who entrust themselves to the care of health professionals when they are admitted to hospital. There can be few more emotive scenarios than that of the patient ‘brought back to life’ following a cardiac arrest by the prompt and expert efforts of the crash team, or alternatively of the patient who is denied a similar chance of survival because of her age or disability (as has been alleged is sometimes the case in UK hospitals). Of course the question of whether to attempt CPR is not as straightforward as these scenarios suggest. The success rate is low, even in the best circumstances, and there is a possibility of significant harm to the patient. The age and existing medical condition of the patient may alter both the likelihood of success and the risk of harm. The phrase ‘medically futile’ has been used to justify the decision to make a Do Not Attempt Resuscitation (DNAR) order, as well as to argue for not discussing the decision with the patient.1,2 What are the ethical considerations that should inform DNAR decisions and is the concept of medical futility helpful in reaching an ethically justifiable decision?