Medical Futility and Treatment Effect in DNR Orders

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Determining when medical care is ineffective, either at producing a desired physiologic effect or a benefit for the patient, is of growing interest. This interest, in what has been called medical futility in the bioethics literature, is the product of rising concern regarding issues of quality of life, patient autonomy, the use of technology and the allocation of scarce medical resources. This research uses medical futility as the conceptual framework from which to investigate the role of risk of death and expected quality of life in the assignment of a do not resuscitate (DNR) order. In addition, it will determine whether the assignment of a DNR order results in an increased risk of death for those who receive them compared to those who do not. This secondary analysis of a well-developed data set on hospitalized, stroke sufferers will use a variant of the bivariate probit model and logistic regression to answer the following specific aim is: 1. To determine whether having a DNR order results in an excess risk of death (DNR treatment effect). 2. To understand how both quantitative futility, (i.e., the risk of death), after controlling for the treatment effect of having a DNR, and qualitative futility, or the expectation of poor quality of life, is related to the assignment of a DNR order.