Family Consent to Orders Not to Resuscitate

To the Editor. — Hackler and Hiller's¹recent article addressing the need to reconsider hospital resuscitation policies was valuable in furthering the exchange of ideas on the "futility" of treatment. In the same issue, Tomlinson and Brody²also argue for the limiting of resuscitative efforts in the face of futility. However, the two points of view diverge at the important point of informing the patient or the incompetent patient's family that medical therapies would be clearly fruitless. Tomlinson and Brody, as well as Youngner³in a commentary on both articles, encourage discussion on the futility of therapy with the patient and family for a variety of reasons, such as facing denial of death. In contrast, Hackler and Hiller's first proposal states that "hospital policy should allow physicians to write DNR orders without family [or patient] consent or discussion, if CPR would be futile."1 However, even when treatment