Recent recommendations that physicians be allowed to withhold cardiopulmonary resuscitation, without patient consent, from patients for whom it would be futile have drawn objections that such unilateral judgments would undermine respect for patient autonomy. These objections assume that since futility determinations involve value judgments, patient input is always required. However, certain sorts of value judgments must be made unilaterally by physicians as part of reasonable medical practice. Moreover, the mixed messages inherent in requesting patient consent to withhold futile therapy serve to undermine rather than to enhance autonomous choice. Real patient interests can better be saved by a broad public dialogue around judgments of medical reasonableness and medical futility, rather than concern for the form but not the substance of patient autonomy.
KIE: It has been suggested that physicians be allowed to withhold resuscitation without seeking patient consent where the procedure would be a futile intervention. These proposals have been criticized on the grounds that such unilateral decision making by physicians would undermine patient autonomy since the determination of futility involves value judgments and should include patient input. Tomlinson and Hahn first examine arguments against futility determinations based on physician value judgments about probability of survival or quality of life after resuscitation. They argue that good medical practice sometimes involves unilateral decision making that incorporates value judgments. Moreover, patient autonomy could be undermined rather than enhanced when a physician, believing that resuscitation would be futile, nonetheless offers it to a patient as an option. Tomlinson and Hahn conclude with a call for broader public dialog on the limits of medical intervention.