Resuscitation: How Do We Decide?

To the Editor.— Charlson et al 1 al1 present a rich analysis of the clinical practice in their hospital concerning levels of intervention in the care of the hospitalized patient. Such a project offers much insight from the perspective of descriptive ethics but does not, in and of itself, lead to any prescriptive statements from the viewpoint of normative ethics. First, they argue that discussions with patients concerning appropriate levels of care can provoke undue anxiety. Although there are some empiric data to support this statement, 2 I do not believe that this concern is alone sufficient to avoid such dialogue. In fact, such discussion might allow for a greater sense of patient control and input, which may not only be clinically beneficial 3 but also, more importantly, morally required. Second, they list the "legal standards for evaluating resuscitation status" as irreversible disease, irreparable physiologic deterioration, and imminent death. I am