Medical Futility and Treatment Effect in DNR Orders

确定医疗护理何时无效，无论是在产生期望的生理效果还是对患者的益处方面，都越来越受到关注。这种对生物伦理学文献中所谓的医疗无用性的兴趣是对生活质量、病人自主权、技术使用和稀缺医疗资源分配等问题日益关注的产物。本研究以医疗无效为概念框架，探讨死亡风险与预期生活质量在拒绝抢救（DNR）命令分配中的作用。此外，它还将确定DNR命令的分配是否会导致那些接受它们的人与那些没有的人相比死亡风险增加。对住院中风患者的成熟数据集进行的二次分析将使用双变量概率模型和逻辑回归的变体来回答以下具体目标：1.确定是否有一个DNR顺序导致死亡的风险过高（DNR治疗效果）。2.为了理解数量上的徒劳（即，死亡的风险），在控制了DNR的治疗效果后，定性无效，或预期生活质量差，与DNR顺序的分配有关。

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.