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Cardiopulmonary resuscitation ethics: a response to Michael Ardagh

SIR

There are some important flaws in Michael Ardagh's reasoning.1

1. Cardiopulmonary resuscitation (CPR) is a “blanket term” for different interventions. Curative and supportive treatments have different ethical contexts and cannot be discussed at the same level. It is imperative to ascribe curative interventions within CPR (defibrillation, pneumothorax drainage, etc) the same status as any other curative intervention, such as antibiotics for infections or surgery for appendicitis. Then we will be able to discuss the ethical context of purely supportive measures such as chest compressions. To address the “ethics of CPR” is a dangerous misnomer.

The preferences of emergency personnel2 suggest the willingness to undergo curative interventions early during CPR, but not protracted supportive interventions. Conversely, withholding curative interventions during CPR should only be considered when any curative treatments would also be withheld.

2. Cardiopulmonary resuscitation is performed to offer the patient a benefit. However, CPR as a whole is only marginally effective. …