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J. Randall Curtis, MD, MPH; David R. Park, MD; Melissa R. Krone, MS; Robert A. Pearlman, MD, MPH
University of Washington Seattle

JAMA. 1995;274(4):300.

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In Reply.

—Our empirical study of the application of the medical utility rationale in DNAR by medical residents suggested this concept was not being used to avoid discussing end-of-life issues with patients or their families, but showed some important misunderstandings of quantitative and qualitative futility. Dr Epstein makes the good point that medical schools and postgraduate medical training programs do not adequately train students and residents in a number of important skills such as delivering bad news, providing informed consent, taking a sexual history, and discussing end-of-life issues. Further work is needed in each of these areas to identify methods that improve these skills.

Dr Tomlinson and Ms Czlonka raise a specific concern with our analysis and interpretation of residents' understanding of quantitative and qualitative futility. We found that, for many patients, multiple rationales for the DNAR order existed. For example, for a given patient it was possible that the . . . [Full Text PDF of this Article]

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