Editorial |

Not Practicing What We Preach

John D. Lantos, MD1
[+] Author Affiliations
1Children’s Mercy Bioethics Center, University of Missouri at Kansas City, Missouri
JAMA Pediatr. 2013;167(10):899-900. doi:10.1001/jamapediatrics.2013.2495.
Text Size: A A A
Published online


Physicians who care for critically ill children often do not know which babies are going to die. Even when experienced clinicians predict that a baby will die, they are often wrong.1 Clinicians must develop strategies to communicate with parents and to make decisions under conditions of significant prognostic uncertainty.

The study by Sanderson and colleagues2 shows that many physicians think that they do not do a good job at discussing do-not-resuscitate (DNR) orders. These physicians believe that DNR orders should be discussed early in the course of a child’s illness, before the child is acutely ill. They also believe that a DNR order should only mean that cardiopulmonary resuscitation should be withheld. A DNR order should not lead to other changes in treatment. Nevertheless, most of these clinicians discuss DNR orders with parents only when children are critically ill. Furthermore, they report that DNR orders often lead to the limitation or withdrawal of diagnostic and therapeutic interventions other than cardiopulmonary resuscitation. Clinicians apparently do not practice what they preach.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics