Restricting CPR to Patients Who Provide Informed Consent Will Not Permit Physicians to Unilaterally Refuse Requested CPR

Abstract:     
Bishop and colleagues (Am. J. Bioethics 2010) are rightly critical of presumed in-hospital cardiopulmonary resuscitation (CPR). But their analysis is plagued by a fundamental conflation. On the one hand, Bishop and colleagues devote significant space to targeting the 'presumption that CPR/ACLS will be performed.' On the other hand, they enthusiastically commend the UK model, which permits providers to unilaterally refuse patient- or surrogate-requested CPR. Bishop and colleagues suggest that these two distinct subjects are fused in such a way that getting rid of the CPR presumption will bring us to the UK model.

However, this author believes this is false. The relationship between the presumption and the UK model is actually far flimsier and weaker than Bishop and colleagues advance. Even without the presumption, U.S. patients and surrogates may (and will) continue to demand CPR. So, even without the presumption, U.S. providers will still 'feel coerced into applying medical interventions that may not be medically indicated.' This article addresses the presumptions in the U.S. about providing in-hospital CPR. It also draws a connection with the UK model of CPR presumption.

Keywords: CPR, cardiopulmonary resuscitation, hospital, healthcare, ACLS, surrogate, statutorily mandated, DNAR, UK, United Kingdom

JEL Classification: K32

Accepted Paper Series