Ethics at the end of life

Some of the physician’s most difficult decisions involve whether to give cardiopulmonary resuscitation (CPR). Current research, hospital policies, and case law provide little guidance for these decisions, but medical ethics offers three useful principles. All three are based on patients’ wishes. First, a victim of cardiopulmonary arrest should receive CPR unless compelling reasons indicate he would not want it. Second, a patient has the right to refuse CPR. Finally, if CPR will serve no therapeutic goals defined from the patient’s wishes, it should not be given. Applying these principles requires a sympathetic, directed history which elicits the patient’s wishes relevant to resuscitation. This article uses an actual case and a simple algorithm to show how these principles promote ethically sound resuscitation decisions. Received from the Division of General Medicine, Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas.