LETTER
CPR-Not-Indicated and Futility
Lawrence J. Schneiderman, MD, and
Nancy S. Jecker, PhD
1 January 1996 | Volume 124 Issue 1 Part 1 | Page 77
TO THE EDITOR:
Although there is much to criticize in the paper of Waisel and Truog [1], we confine ourselves to one fundamental point. The authors echo the assertion that physiologic futility is somehow free of "imposed value judgment" [2]. By contrast, we have pointed out [3] that making physiologic function the object of medical treatment is not value free but rather a value choice, which, in our opinion, is about as far from a patient-centered goal of medicine as it is possible to be. Waisel and Truog do not say exactly why they consider physiologic futility to be free of value judgments. However, their statement that "definitions of physiologic function (such as circulation and ventilation) ... are more technical in nature and do not involve substantial value judgments" suggests that they have succumbed to what Alvan Feinstein has called the "curse of Kelvin," namely, "the basic sentiment is: When you cannot express it in numbers your knowledge is meager and unsatisfactory" [4]. In other words, it is easier to count heartbeats and respiration than to determine when the patient no longer has the capacity to appreciate these organ functions as a benefit. This ease of measurement therefore provides the rationale for calling heartbeats and respiration the goals of medical treatment. Lord Kelvin himself is reported to have said, "All science is measurement but not all measurement is science." Similarly, we submit that all medicine represents outcomes, but not all outcomes represent medicine.
|
Author and Article Information
|
|---|
University of California, San Diego; La Jolla, CA 92093-0622
University of Washington; Seattle, WA 98195
1. Waisel DB, Truog RD. The cardiopulmonary resuscitation-not-indicated order: futility revisited. Ann Intern Med. 1995; 122:304-8.
2. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med. 1992; 326:1560-4.
3. Schneiderman LJ, Faber-Langendoen K, Jecker NS. Beyond futility to an ethic of care. Am J Med. 1994; 96:110-4.
4. Feinstein AR. On exorcising the ghost of Gauss and the curse of Kelvin. In: Clinical Biostatistics. St. Louis: Mosby; 1977:235.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
