Life-Sustaining Therapy: A Model for Appropriate Use

Abstract

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)