CPR Musings

I'm in the midst of a spirited debate with professional colleagues in SE Wisconsin regarding the role of patient autonomy in CPR decisions.  On the one side are those who belive it is appropriate for patients to indicate their CPR preference on an advance directive form. Question: Do you want CPR if your heart stops? Yes or No.  (Note: The statutory Wisconsin Power of Attorney Health Care document does not include a CPR question, but many health care centers have amended the state form to include this CPR question).  Their argument is that a) patients have a right to voice their opinion which honors their autonomy and 2) having patients state their preference provides their health care professionals important information as to the patient's end-of-life preferences.  I stand firmly on the other side of the debate, arguing that CPR is a medical procedure, with risks/benefits/alternatives.  We don't ask patients to state their future preference to other life saving medical procedures, If you develop liver failure, would you like to receive a liver transplantant?  Yes or No.  I argue that a CPR discussion should only be conducted by a health professional who 1) can present risks/benefits/alternatives; 2) contextualize the use of CPR for the individual patient's medical condition; and 3) is prepared to make a recommendation on the use of CPR as a medical procedure, based on medical knowledge and experience.   From my perspective, the argument boils down to a difference of opinion on the role of patient autonomy vs. professionalism and whether or not you agree that CPR is a medical procedure.  For those interested in reading more, my favorite articles by truly great thinkers/writers are:

Quill TE and Brody H.  Physician recommendations and patient autonomy: Finding a balance between physician power and patient choice. Ann Int Med 1996;125:763-769. 

Tomlinson T and Brody H. Ethics and communication in do-not-resuscitate orders. NEJM 1988; 318:43-46.