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Donald J. Murphy, MD
George Washington University Medical Center Washington, DC

JAMA. 1989;261(11):1582.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—

I agree with Drs Blackhall, Brody, and Tomlinson. We should discuss advance directives, including CPR, with our patients and their families. The question I raise is whether we must discuss CPR before writing a DNR order for severely demented patients or patients for whom CPR is futile.

The policy I propose should not imply that we curtail communication with patients and families. Simply writing a DNR order does not excuse the physician from discussing life-sustaining therapies (feeding tubes, intravenous antibiotics, emergency surgery, and so on) that can profoundly alter the last months or years of our patients' lives. When these issues are addressed, a discussion of CPR will follow.

Dr Blackhall suggests that the decision to withhold CPR because of poor quality of life can be made only by patients and their families. In most cases, I agree. But what about the severely demented patient, bedbound with decubitus . . . [Full Text PDF of this Article]

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