In their recent article, Waisel and Truog [1] attack unilateral do-not-resuscitate policies that use definitions of futility encompassing more than physiologic functioning. They rest their claim on the belief that a physiologically based conception of futility does not lead to the imposition of value judgments on patients. This assertion, however, is flawed. Consider a patient desiring antibiotics for what her physician concludes is a viral illness [2]. In this instance, antibiotic therapy would be futile in a physiologic sense. However, the patient may view her interaction with the physician differently; treatment may give the patient a sense of satisfaction that she values highly and may help to fulfill important emotional and psychological goals. The existence of the placebo effect supports this conclusion and further shows that values are at issue in all aspects of the physician-patient encounter.

More distressing, however, is the fact that unilateral do-not-resuscitate policies may undermine the physician-patient relationship. Physicians currently cannot resolve the do-not-resuscitate issue without discussing it with their patients. They must talk honestly and openly about prognosis and the possible use and value of resuscitation. Often, such conversations prove both cathartic and beneficial for all involved [3]. They visibly show the physician's commitment to his or her patient. Knowing that one can write a do-not-resuscitate order over the objection of a patient may remove part of the impetus that leads to such conversations. In turn, clinicians may devote less time to these important topics. As a result, the bond linking the physician and patient may be weaker than it would have been otherwise.