Wednesday, October 11, 2006

The Last Word on the Last Breath - New York Times

But the question of who has final say over whether CPR should be attempted on a gravely ill patient — the doctor, the patient or the patient’s representative — is live and unsettled in law and medicine.


The debate over who makes the decision raises fundamental challenges to medical integrity as well as patients’ rights and can rub feelings raw for all concerned. Hospitals around the country and some state legislatures have wrestled with how to balance these competing values, reaching different conclusions.


Dr. Fins thinks that the focus on D.N.R. orders is in itself misguided.

“D.N.R. is a game plan for the last 15 minutes of your life,” he said. “By planning for those last 15 minutes, we’re distorting priorities. Instead of talking about futility, we should be discussing what has utility, like pain management, comfort, closure. Recasting the discussion has led to turning irresolvable dilemmas into problems that can be addressed.”

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