Life-sustaining therapy. A model for appropriate use.

Published

Journal Article

New strategies are needed to curb the proliferation of life-sustaining therapies that rarely benefit patients. We propose a model for appropriate use of such therapies that incorporates effectiveness, utility, and marginal costs. If a therapy is rarely effective and rarely desirable, it is considered medically inappropriate. If the marginal cost-effectiveness ratio is inordinately high, it is considered economically inappropriate. If a therapy is either medically or economically inappropriate, it should not be automatically offered. The model provides an operational definition of futility and is illustrated with an analysis of out-of-hospital cardiopulmonary resuscitation for chronically ill older people. Advance directives, explicit health care rationing, and defining futile therapy based on survival predictions are alternatives to the appropriate care model, but are insufficient strategies to solve the problem of inappropriate life-sustaining care.

Full Text

Duke Authors

Cited Authors

  • Murphy, DJ; Matchar, DB

Published Date

  • October 1990

Published In

Volume / Issue

  • 264 / 16

Start / End Page

  • 2103 - 2108

PubMed ID

  • 2120480

Pubmed Central ID

  • 2120480

Electronic International Standard Serial Number (EISSN)

  • 1538-3598

International Standard Serial Number (ISSN)

  • 0098-7484

Digital Object Identifier (DOI)

  • 10.1001/jama.264.16.2103

Language

  • eng