Human Exceptionalism

CPR Usually Not Futile–Even in Terminal Illnesses

This is interesting, considering the drive to refuse wanted CPR as “futile” when people are terminally ill. From a study published in the Journal of Hospice and Palliative Nursing–Vol. 10, No. 3, May/June 2008 (no link available):

There is little evidence CPR is not effective and–hence inappropriate–in end-stage disease. The strongest evidence appears for cancer patients in critical care who experience cardiac arrest as a consequence of multisystem organ failure. This population would meet criteria for not initiating CPR.

However, decisions about the appropriateness of CPR encompass more than quantitative survival. A qualitative approach that addresses benefit from a broader goal-directed perspective must be considered. Benefit of CPR, to some extent, is in the eye of the beholder.

Yes indeed. And that is why coercion in these matters is wrong. But with proper education, a better choice might be made. Thus the article urges a properly detailed discussion of whether to request CPR:

Before the Patient Self-Determination Act (PSDA), goals and decision making were often framed from a medical perspective. Since the enactment of the PSDA, patient-centered goals and decision making take precedence; however, healthcare providers have a responsibility to provide the medical information necessary to make an informed decision about CPR and make professional recommendations…However, large-scale studies of seriously ill adults have demonstrated that CPR discussions are often late and/or lacking. CPR in end-stage disease may not be inappropriate; however,the current practice of making CPR a routine part of the dying process without timely dialogue is very inappropriate.

Educate. Persuade. Cajole, even: But do not force. This is the best way to obtain the most beneficial outcomes for the most patients while maintaining the people’s trust in the integrity and beneficence of medicine.

HT: Heather Seierstad

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