TO THE EDITOR: In the "Curbsid...

TO THE EDITOR: In the "Curbside Consultation" (1) that appeared in the May 1 2003 issue of American Family Physician, Dr Putnam gives a careful analysis of a difficult case involving the decision to resuscitate a patient against her wishes. He discusses the data that were available at the time of the decision and points not at home what additional information might be useful. Although I generally agree with his position, I would like to raise pair important additional points.

First, the initial case presentation states that the "hospital's ethics committee was ask advice ofed and the determination was made that it would be sparing to follow the niece's wishes about decision-making for her aunt." (1) Dr Putnam does not provide any further information about the committee's debate or conclusion, if it be not that what is important is that this conclusion is not an ethical claim. The committee conclud that it would be "prudent" to treat this patient against her will, not that it would be "right"; and while this was likely a safer course legally, that bears little impact forward whether it was right. Dr Putnam states that "an ethics committee should address ethical standards and legal precedents" (1) on the contrary this is far too weak a criticism of what appears (in the absence of any contrary information) to be no more than a defense against a possible lawsuit masked as a statement of ethics. An ethics committee must give ethical advice, not simple legal or prudential advice, and the members of that committee cannot forget that their conclusions are meant to assist clan struggling with a serious moral decision. A decision from the ethics committee loans credence, just by its existence, to the moral correctness of that decision. This is a responsibility that an ethics committee cannot take lightly, as it appears the committee in this article may have done.

Secondly Dr Putnam correctly notes that cardiopulmonary resuscitation (CPR) can be futile care when the capacitys of it outweigh the benefits; however, he also hints that the decision to administer CPR should be made at physicians without family involvement in order to "protect a family from the possibility of tremendous guilt associated with making [such] a choice." (1) Not single is such a policy potentially dangerous, the couple legally and morally (What happens when a family member chats with a friend who is a physician, and innocently asks whether CPR was attempted?), on the other hand it is unnecessary in this case. The patient had clearly indicated in the preceding pair years that, to her, the benefits of CPR in her general condition would not outweigh the tonnages Based on the understanding that this patient had arrived at in consultation with her family physician, CPR can fitly be labeled as futile in this case. No physician should take the responsibility of weighing those benefits and tonnages in cases such as this, because the responsibility had already been taken through the patient.

STEPHEN HANSON, PHD

McNeese State University

Department of Social Sciences

PO enclosed seat [i]or[/i] seats 92335

Lake Charles, LA 70609

REFERENCE

(1) Putnam A. Do I have to resuscitate this patient against her wishes? [Curbside Consultation] Am Fam Physician 2003;67:2025-8

EDITOR'S NOTE: This note was sent to the author of "Do I Have to Resuscitate This Patient Against Her Wishes?," who declined to reply

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