Life-Sustaining Therapy: A Model for Appropriate Use
Murphy, Donald J.
Matchar, David B.
JAMA. 1990 Oct 24/31; 264(16): 2103-2108.
The authors propose a mathematical model for deciding appropriate use of life-sustaining care, using as an example out-of-hospital cardiopulmonary resuscitation for chronically ill older persons. Incorporating determinations of effectiveness, utility, and marginal costs, the model helps physicians and patients decide which life-sustaining treatments are medically and/or economically appropriate. Physicians need not automatically offer patients therapies that have been shown to be neither medically nor economically appropriate. Murphy and Matchar discuss advance directives, health care rationing, and identifying futile therapies based on survival predictions as other mechanisms for limiting life-sustaining care. They conclude that these three options are inadequate alternatives to the appropriate care model. (KIE abstract)
Adults; Advance Directives; Aged; Aids; Allowing to Die; Alternatives; Chronically Ill; Costs and Benefits; Critically Ill; Decision Making; Economic Value of Life; Emergency Care; Evaluation; Futility; Health; Health Care; Health Care Rationing; Life; Mortality; Patient Care; Patient Participation; Patients; Physicians; Policy Analysis; Prognosis; Public Policy; Quality of Life; Refusal to Treat; Resource Allocation; Resuscitation; Resuscitation Orders; Risks and Benefits; Selection for Treatment; Standards; Statistics; Terminal Care; Value of Life; Values; Withholding Treatment;
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Life-Sustaining Treatment Preferences of Hemodialysis Patients: Implications for Advance Directives Singer, Peter A.; Thiel, Elaine C.; Naylor, C. David; Richardson, Robert M.A.; Llewellyn-Thomas, Hilary; Goldstein, Marc; Saiphoo, Carl; Uldall, P. Robert; Kim, Donald; Mendelssohn, David C. (1995)
Life-Sustaining Treatment Preferences of Hemodialysis Patients: Implications for Advance Directives Singer, Peter A.; Thiel, Elaine C.; Naylor, C. David; Richardson, Robert M.A.; Llewellyn-Thomas, Hilary; Goldstein, Marc; Saiphoo, Carl; Uldall, P. Robert; Kim, Donald; Mendelssohn, David C. (1995-11)The purpose of this study was to describe the life-sustaining treatment preferences of dialysis patients and to compare the acceptability of two generic and a disease-specific advance directive (AD). Of 532 potentially eligible ...