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Life-sustaining therapy. A model for appropriate use.

Publication ,  Journal Article
Murphy, DJ; Matchar, DB
Published in: JAMA
October 24, 1990

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.

Duke Scholars

Published In

JAMA

ISSN

0098-7484

Publication Date

October 24, 1990

Volume

264

Issue

16

Start / End Page

2103 / 2108

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Value of Life
  • United States
  • Social Values
  • Risk Assessment
  • Resuscitation
  • Resource Allocation
  • Patient Participation
  • Mortality
  • Morbidity
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Murphy, D. J., & Matchar, D. B. (1990). Life-sustaining therapy. A model for appropriate use. JAMA, 264(16), 2103–2108.
Murphy, D. J., and D. B. Matchar. “Life-sustaining therapy. A model for appropriate use.JAMA 264, no. 16 (October 24, 1990): 2103–8.
Murphy DJ, Matchar DB. Life-sustaining therapy. A model for appropriate use. JAMA. 1990 Oct 24;264(16):2103–8.
Murphy, D. J., and D. B. Matchar. “Life-sustaining therapy. A model for appropriate use.JAMA, vol. 264, no. 16, Oct. 1990, pp. 2103–08.
Murphy DJ, Matchar DB. Life-sustaining therapy. A model for appropriate use. JAMA. 1990 Oct 24;264(16):2103–2108.
Journal cover image

Published In

JAMA

ISSN

0098-7484

Publication Date

October 24, 1990

Volume

264

Issue

16

Start / End Page

2103 / 2108

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Value of Life
  • United States
  • Social Values
  • Risk Assessment
  • Resuscitation
  • Resource Allocation
  • Patient Participation
  • Mortality
  • Morbidity