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Public Awareness of the Nature of CPR: A Case for Values-Centered Advance Directives

Cardiac arrest and the need for cardiopulmonary resuscitation (CPR) can punctuate any phase of a serious illness. It can happen when a patient presents with an acute myocardial infarction, during a patient’s recovery from anesthesia after major abdominal surgery, or when a patient with chronic lung disease develops respiratory failure from pneumonia. In whichever circumstance it occurs, CPR is an invasive procedure whose sole purpose is to reverse cardiac arrest. As such, it may either restore life or be futile, depending on background medical circumstances. If life is restored, its duration and quality may then be problematic. A patient’s decision whether or not to allow CPR is usually made either with (1) the attending physician during a critical illness or (2) before an illness by an advance directive or in conversations with potential surrogates, or both. Regardless of its context, this decision is about a highly invasive treatment, and patients should consent or refuse only after receiving full disclosure which includes, among other things, understanding the nature of the procedure. As a medical procedure, CPR is probably better known to the general public than are renal dialysis and invasive cardiac monitoring. Given CPR’s central position in end-of-life treatment plans and the importance of informed consent in general, the question arises about the extent of patients’ comprehension of CPR’s actual nature. The literature addresses patients} preferences in considering do-not-resuscitate (DNR) decisions with physicians, but these discussions usually entail prognosis, risks, and alternatives. Little information exists about what the public knows about the actual nature of medical procedures, including CPR. This study tests the hypothesis that a statistically significant lack of knowledge about CPR exists among the general public as compared to the medical profession, and that this lack is independent of age, gender, education, or former experience with CPR. From these findings implications about advance directives will be discussed. First, what a low baseline knowledge of medical procedures mean in achieving satisfactory informed consent about end-of-life treatment strategies? Second, how does the problem of obtaining such informed consent fit into the proper use of advance directives?