Abstract
A recent paper in this journal (1) suggests that involving terminally ill patients in choices concerned with Cardio-Pulmonary Resuscitation (CPR) produces 'psychological pain' and therefore is ill-advised. Such a claim rests on anecdotal observations made by the authors. In this paper I suggest that drawing conclusions in ethics, no less than in science, requires a rigorous framework and cannot be relegated to personal observation of a few cases. The paper concludes by suggesting that patients, if we acknowledge their valid interest in making their own choices, must themselves be allowed to make a prior choice about choosing. Those who may not wish to choose may properly be relieved of this burden and may allow another to choose for them. Routinely allowing others to make choices for competent adults, however, is likely to decrease communication with the dying patient and to introduce an atmosphere of suspicion and fear and to exclude the competent patient from his/her rightful place in the community.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bedell S. E., Delbanco T. L., Cook E. F., Epstein F. H. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983 Sep 8;309(10):569–576. doi: 10.1056/NEJM198309083091001. [DOI] [PubMed] [Google Scholar]
- Blackhall L. J. Must we always use CPR? N Engl J Med. 1987 Nov 12;317(20):1281–1285. doi: 10.1056/NEJM198711123172009. [DOI] [PubMed] [Google Scholar]
- Loewy E. H. Patient, family, physician: agreement, disagreement, and resolution. Fam Med. 1986 Nov-Dec;18(6):375–378. [PubMed] [Google Scholar]
- Loewy E. H. Treatment decisions in the mentally impaired. Limiting but not abandoning treatment. N Engl J Med. 1987 Dec 3;317(23):1465–1469. doi: 10.1056/NEJM198712033172308. [DOI] [PubMed] [Google Scholar]
- Pearlman R. A., Speer J. B., Jr Quality-of-life considerations in geriatric care. J Am Geriatr Soc. 1983 Feb;31(2):113–120. doi: 10.1111/j.1532-5415.1983.tb05425.x. [DOI] [PubMed] [Google Scholar]
- Schade S. G., Muslin H. Do not resuscitate decisions: discussions with patients. J Med Ethics. 1989 Dec;15(4):186–190. doi: 10.1136/jme.15.4.186. [DOI] [PMC free article] [PubMed] [Google Scholar]