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Do You Have a Duty to Perform CPR?

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An 87-year-old woman drops to the floor. An ambulance is called but no one performs CPR while they wait for it. She dies. Is it a crime? A tragedy? Did she have a civil right to receive CPR? Did onlookers have a moral obligation to give it to her? Did her assisted living facility's policy of not providing medical care go too far?

These are the questions being debated after Lorraine Bayless died. To me, the better question is: "What would she have wanted?"

Bayless was 87, at the end of her life expectancy. She willingly entered that facility and understood the policy against medical treatment. No doubt, she'd lost friends and relatives and had seen the agony at the end of many lives. I was relieved to read this morning that her family says she wanted a natural death. She had one. It is always difficult to lose a loved one, but I hope her family can find some peace in that. I find the idea of a natural death at an advanced age very satisfying because that's what I want, too.

I think we all have a right to die the way we want. My biggest concern is whether many of our life-saving techniques just prolong a life of suffering. I have seen, and have written about in my book, Finding Frances, the agony that many times accompanies our heroic efforts to stem the force of Mother Nature. I've seen families torn apart and decision makers overcome with guilt, all because doctors refuse to say -- for personal, ethical or legal reasons: "That's all I can do," even though they know additional treatment is futile.

It all comes down to our Western culture. If we cheat death, we are champions. We take pride in dodging the bullet -- life saved by a quick move in the nick of time. We celebrate survivors. But when we lose (which we all ultimately will), we are death's victims. If our health care workers can't save us, they feel incompetent and face lawsuits and disciplinary action. And as we read in the case of Bayless and her nurse, possible criminal charges.

But the family says Bayless wouldn't have wanted to be revived. That is definitely counterculture in our never-say-dying culture. A study of resuscitation decision making in the elderly (Schonwetter, et al.) concludes that the more people were informed about CPR outcomes, the more likely they were to reject it. It's hard for many people to process that. But not fighting death is not the same as giving up. It's just accepting the normal course of events without hanging on to the false belief that technology can make us immortal, or the false belief that by turning over the responsibility for our deaths to the medical system, they will work magic beyond our own abilities.

Most of us say we don't believe what we see on television, yet most if us have this cinematic idea that CPR usually works, right? Wrong. A Seattle study led by Dr. W.T. Longstreth Jr., reported in the Journal of the American Medical Association, showed that only 10 percent of cardiac-arrest patients over 70 survived long enough to go home. Dr. Robert Schmerling of the Harvard Medical School writes, "The value and limitations of CPR continue to evolve." He believes that when elderly victims have multiple medical problems, it works less than 5 percent of the time when properly administered.

Dr. David Davis, an emergency room doctor for more than 30 years, has resuscitated 600 people. "It's violent," he said in an interview in the New York Times. If CPR is performed correctly, hard and fast with a compression depth of at least 2 inches, "you're going to break ribs and maybe the sternum," he admits. Obviously, older people are going to have a harder time healing, if they heal at all, from that.

Dr. David John, former geriatrics chairman of the American College of Emergency Physicians, puts it simply in the New York Times piece: "When your heart stops, it's really hard to get it back." Still, he says, "I'd want to give CPR a shot." After all, you can't win if you don't play, can you? CPR can double or triple your chances of survival, and when your heart has already stopped beating the chance of dying is nearly 100 percent.

I can see both sides of the argument. It's a matter of choice, really, isn't it? There may come a day that regulations actually require us to perform CPR. Vermont already imposes a fine if you can try to help but don't. But I think this is going in the wrong direction. In my mind, the answer is individual and deeply personal.

A neighbor of mine once collapsed with heart failure. With my Red Cross training, I've saved two choking people by administering the Heimlich maneuver. I just couldn't bring myself to do CPR on the neighbor. Why? In all my training I'd never realized that, if you're doing CPR on someone, they're already dead. They look dead and act dead. I was terrified and overwhelmed. I can't say I wouldn't do the same thing again.

Do we have a duty to perform CPR?

Not in my mind. The only obligation I can see all of us having is to know what we want at the time of our deaths and to advise those closest to us and our medical providers of our decisions. Advance care directives, health care surrogates, physician orders for life sustaining treatments (POLST), and do not resuscitate orders (DNR) are the vehicles for us to remove the questions and provide the answers so our names don't make the headlines tomorrow.

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