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Medical Futility: Where's the Attending?-Reply

Nancy S. Jecker, PhD; Robert A. Pearlman, MD, MpH
Arch Intern Med. 1992;152(12):2506. doi:10.1001/archinte.1992.00400240117022.
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In Reply.—  We appreciate the thoughtful letter of Matz highlighting the importance of the attending physician's involvement in all deliberations about medical futility. However, we do not agree with his blanket conclusion that "the ultimate decision" concerning futility rests with the attending physician.We wish to reinforce the concept that there are circumstances in which a patient (or surrogate) can legitimately trump even an attending physician's judgment of qualitative futility. This would occur in cases where the individual physician's judgment is not supported by broader community standards. One kind of situation occurs when community consensus does not exist about whether the quality of a treatment outcome is acceptable. In such a situation, a patient's request for treatment cannot be overridden by an attending physician's claim that treatment is futile. An example is a conscious patient who is ventilator dependent. A second kind of situation occurs when an attending physician regards


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