Revising CPR Default Status

Craig Blinderman and colleagues have, in a recent issue of JAMA, a persuasive and succinct three-part approach to offering CPR based on the likelihood and degree of potential benefits and harms.

1. Where relative benefits and harms are uncertain, consider CPR as a plausible option.


2. Where there is a low likelihood of benefit and a high likelihood of harm, recommend against CPR.  They note that despite such a recommendation, some patients or surrogates may request that CPR be attempted.  Blinderman and colleagues conclude that it is ethically acceptable to acquiesce "so long as it is grounded in the patient's wishes and goals and there is a potential for a modicum of benefit."


3. Where the patient will die imminently or has no chance of surviving CPR to the point of leaving the hospital, physicians should not offer CPR.  If a patient or surrogate continues to insist, request an ethics consult.  If the consult concurs, then the patient/surrogate should be informed that CPR will not be attempted and psychological/emotional/spiritual support should be made available.  Blinderman and colleagues do note that even here CPR might be attempted if the patient has "highly unusual values or goals."