Involving patients in decisions about their care is morally, legally, and clinically desirable, whatever their age. The use of do not resuscitate orders, when a decision is made not to give a patient cardiopulmonary resuscitation, is common. In the United States patient consent is a universal requirement for do not resuscitate orders and is enshrined in hospital policies and state law. in Britain this approach is resisted on the grounds that it replaces the humane tradition of medical care with a formulaic adherence to policy.1 But the ethical principle of respect for patients' autonomy and the practical objective of benefiting patients with minimal harm necessitate involving patients in these decisions.2

We need to establish humane, valid, and reliable ways of ascertaining patients' views. Only when discussing do not resuscitate orders would harm patients, or when cardiopulmonary resuscitation would be futile, should competent patients not be consulted. Three papers in this week's journal concern the withholding of cardiopulmonary resuscitation: Hill et al and Morgan et al have surveyed doctors' and patients' views on cardiopulmonary resuscitation (p 1677,3 p 16774); Doyal and Wilsher discuss the moral and legal implications …