Futility and unilateral decision making: a different view.

... Resuscitation of PVS patients is futile if the goal is to restore the patient to a cognitive or conscious state but not if the goal is restoration of respiratory function. The judgment of futility in either case is based on nonmedical (as well as medical) values or criteria, i.e., the value of cognitive life vs. the value of noncognitive life. If all of the affected parties concur that noncognitive recovery is a goal not worth achieving, a DNR order should be written. Lacking such concurrence, justification for a DNR order might be found in societal assessment of the burdens and benefits to others (besides the patient) of providing treatment in such circumstances. This is not a decision to be made unilaterally by a single physician, whose values are not necessarily reflective of those of the patient, family members, other physicians, or society at large.