CPR in terminally ill patients?
While limiting and foregoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. When the patient does eventually die, attempts are frequently made to revive the patient by performing cardiopulmonary resuscitation (CPR). While CPR may result in the establishment of a perfusing pressure, in almost all instances, the patient succumbs despite advanced life support technology. The widespread adoption of do-not-resuscitate (DNR) protocols has not prevented CPR from being performed on patients, who are unlikely to survive. We present two cases, which highlight the modern American way of dying. We submit that poor end-of-life care may result from physicians discomfort with death, their poor communication skills and their failure to fully comprehend the benefits and limitations of advanced life support technology. Furthermore, we maintain that CPR should only be performed on patients, who are likely to derive benefit from this intervention.
Marik
P E
PE
Department of Medicine, Washington Hospital Center, Washington, DC, USA. paul.marik@verizon.net
Zaloga
G P
GP
D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004992:Ethics, Medical; D005260:Female; D015658:HIV Infections / Q000628:therapy; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D008297:Male; D016414:Resuscitation Orders; D013727:Terminal Care; D019452:Terminally Ill