Many people have come to view cardiopulmonary resuscitation (CPR) as a routine intervention following cardiac arrest, and they insist on CPR for their loved ones even when the physician explains its likely futility. Physicians who refuse a family member’s request to perform unwarranted CPR risk becoming the center of media, legal, and disciplinary scrutiny. Although CPR is largely perceived as a benign life-saving intervention, it inflicts indignity and possibly pain on a dying patient and should not be used when it is unlikely to succeed or to benefit the patient if successful. The growing acceptance of do-not-resuscitate orders for patients with advanced cancer has not spread to families of patients suffering from the late stages of other degenerative or terminal illnesses. Having blunt discussions about the true consequences and risks of CPR might foster greater willingness to abstain from administering CPR to patients unlikely to benefit.
This article was originally published by HMP Communications LLC (Annals of Long-Term Care: Clinical Care and Aging), 05/16/2011.
Michael Gordon, MD, FRCPC
Vice President Medical Services and
Head Geriatric and Internal Medicine
Baycrest Centre for Geriatric Care
Head, Division of Geriatrics
Mt. Sinai Hospital
Professor of Medicine
University of Toronto
Cardiopulmonary resuscitation (CPR) is commonly perceived as a miraculous treatment that averts death. For many, the understanding of CPR comes from television and movies where, inevitably, death is cheated by heroic resuscitation. North Americans especially have, since its discovery more than thirty years ago, been fascinated with CPR.1 CPR, however, is not always an appropriate or humane medical procedure. For defined segments of the elderly population, especially those requiring long-term institutional care, it may be a last, undignified rite of passage in a world that has become mesmerized by technology. It is for the benefit of this elderly population that we must strive to tailor our resuscitation policies in order to realistically serve their needs, without exposing them to ineffective CPR attempts. The goal of institutional policy should be to define the framework by which we can provide appropriately humane care without denying CPR to those members of older populations who can, within reason, hope to benefit from it.
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