IN AN earlier article1 we explored ethical decision making in the prehospital emergency setting with particular attention to emergency cardiac care (ECC). We argued in support of recent efforts to develop portable do-not-resuscitate (DNR) policies that allow patients' wishes to be honored outside the hospital setting, such as during interinstitutional transfer, in long-term care facilities, in the home, or elsewhere. We also proposed allowing emergency personnel to cease futile resuscitation in the field. We argued that unlike DNR orders, a judgment that resuscitation is futile should rest with qualified medical personnel and should reflect a professional consensus supported by sound empirical data.
In this article, we examine the most recent American Heart Association (AHA) Guidelines for cardiopulmonary resuscitation (CPR) and ECC.2 While we commend the new guidelines for acknowledging medical futility, we identify shortcomings in the definition of medical futility and suggest further revisions.