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Editorials: POINT/COUNTERPOINT EDITORIALS |

Rebuttal from Dr. Curtis

J. Randall Curtis, MD, MPH, FCCP; Robert A. Burt, JD
Author and Funding Information

Affiliations: Seattle, WA ,  New Haven, CT ,  Dr. Curtis is Professor of Medicine, Departments of Medicine and Medical History and Ethics, University of Washington, Seattle WA; Professor Burt is Alexander M. Bickel Professor of Law, Yale University Law School, New Haven CT.

Correspondence to: J. Randall Curtis, MD, MPH, Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, Box 359762, 325 Ninth Ave, Seattle, WA 98104-2499



Chest. 2007;132(3):754-755. doi:10.1378/chest.07-1331
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In arguing that informed consent is an ethical requirement for a do-not-resuscitate order, Dr. Manthous maintains that assent runs the risk that patients and families will not understand the rationale for withholding cardiopulmonary resuscitation (CPR) and that explanation and communication will be short-changed in this process.1 We would emphasize, however, that our conceptualization of informed assent requires the same amount of explanation and communication as informed consent.2 We advance the concept of “informed assent” in contradistinction to the concept of “assent” as applied in clinical research regarding children. The only difference that we posit between informed consent and informed assent is that the clinician is not insisting that the decision ultimately and expressly be made by the patient or family member, but rather that the patient or family member is informed that they have an option of deferring the decision to withhold this therapy, which is very unlikely to provide benefit in the particular circumstance, to the physician. We agree with Dr. Manthous that, if done poorly, informed assent could be obtained without patients and families fully understanding the decision being made. This risk is, however, also an important concern with informed consent. The solution is not to require informed consent in all situations, but rather to ensure that the communication is conducted well regardless of whether one is seeking assent or consent.

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