To CPR or Not to CPR, that is the question

The following excerpts are from Jan Hoffman, The Last Word on the Last Breath, NY Times, Oct. 10, 2006.

[T]he question of who has final say over whether CPR should be attempted on a gravely ill patient — the doctor, the patient or the patient’s representative — is live and unsettled in law and medicine.

Many doctors believe that their medical judgment about whether CPR will be effective in a given patient’s case, and their knowledge of the havoc it can wreak on a dying body, should prevail. But a patient’s representative, who is often a relative, may believe that every medical option should be exercised and that a miracle could be just a chest compression away. And patients’ families, spurred on by TV medical dramas, often mistakenly believe that CPR is almost always effective — a notion emphatically disproved by studies.

The debate over who makes the decision raises fundamental challenges to medical integrity as well as patients’ rights and can rub feelings raw for all concerned. Hospitals around the country and some state legislatures have wrestled with how to balance these competing values, reaching different conclusions.

New York is one of the few states with a law that directly addresses resuscitation orders. In New York, even when a doctor believes that CPR would be medically futile, if the patient is incapable of indicating a preference for or against it and the patient’s designated representative insists it be performed, the physician must ultimately go to court to prevail. Texas, which has a complex advance directive law that includes checks and balances, ultimately sides with physicians, immunizing them from litigation.

Hawaii passed legislation this year giving great weight to a patient’s “comfort care” document, which specifies the patient’s preferences in dire medical situations. Nonetheless, if the patient has indicated no resuscitation but “the provider’s own conscience” dictates otherwise, a medical professional may override the document.

Special thanks to Neil E. Hendershot of the Harrisburg, Pennsylvania law firm of Goldberg Katzman, P.C., who also authors the PA Elder, Estate & Fiduciary Law Blog, for bringing this article to my attention.