Muriel Gillick, MD
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Gillick M.; CPR for Patients Labeled DNR. Ann Intern Med. 2003;139:704. doi: 10.7326/0003-4819-139-8-200310210-00022
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Published: Ann Intern Med. 2003;139(8):704.
TO THE EDITOR:
In arguing that do-not-resuscitate (DNR) orders should sometimes be replaced by “limited aggressive therapy” orders (LATOs), Choudhry and colleagues (1) acknowledge that treatment-specific orders are potentially perilous: A given procedure may be consistent with a patient's goals in certain situations but not in others. Choudhry and colleagues propose instead enumerating the situations in which cardiopulmonary resuscitation (CPR) might be initiated and specifying in which of those situations it should be attempted. This approach is analogous to Emanuel and Emanuel's “Medical Directive” (2), which lists 4 clinical scenarios and asks in each case which of 11 interventions would be acceptable. Limited aggressive therapy orders are appealing to physicians for their apparent specificity, but they create the same difficulties as the Medical Directive: They fail to consider the patient's goals and require an indefinitely long list of clinical situations.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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