The American journal of medicine
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Recent reports on the use of in-hospital cardiopulmonary resuscitation (CPR) have failed to provide an applicable method to identify patients who have little chance of surviving CPR. We prospectively evaluated the clinical characteristics and outcome of 140 consecutive hospitalized patients who had cardiopulmonary arrest and received CPR, and we propose a method for predicting survival in this setting. ⋯ The PAM Index may be useful in identifying patients in whom CPR may be ineffective.
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The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. ⋯ Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations.