Is 'futility' a prerequisite to a 'do not resuscitate' decision?

To the Editor. —In discussing the data from their prospective study of "do not resuscitate" (DNR) order at three teaching hospitals, I believe that Lo and his colleagues 1 imply that the physicians were ethically wrong in writing DNR orders in the face of family disagreement. To support that conclusion, they pointed to two patients wherein "the physician's assessments of futility were incorrect, perhaps influenced by their judgment of the patient's quality of life; patients in these cases survived to discharge." I believe that the authors' implication is erroneous and that their error stems from their implied suggestion that futility of treatment is a prerequisite to writing a DNR order and from a misunderstanding of the limited nature of the DNR order. In all acute care hospitals, the policy is that without a DNR order, cardiopulmonary resuscitative efforts ("code blue," and so on) will be made in all cases of