Topics Ethics

Question I'm a medical doctor. I have had to do CPR (Cardiopulmonary Resuscitation) in public, outside of the hospital, at least six times in my life. Only one time did a patient recover partly - for another two months. It is a well-known medical fact that a very small percentage of 'resuscitated' subjects recover entirely after their heart attack. If she survives, the patient will often be reduced to a vegetative state. I myself would definitely not want to be administered CPR in case of a heart attack. How does my behaviour/attitude square with the Golden Rule of doing unto others as I would have them do to me? I'm Dutch, and in Holland all medical doctors are sworn in with Hippocrates' Oath, which clearly conflicts with not administering CPR. Should I stop extramural CPR, or honour my oath in spite of myself?

Accepted:
November 3, 2005

Comments

You would not want to have CPR administered to yourself. And you would also not want to be treated contrary to your wishes. In order to apply the Golden Rule, we need to know which of these two desires is controlling. I would think it is the latter. If so, you should administer CPR to those who would want to have CPR administered -- thereby treating them in accordance with their wishes, just as you want to be treated in accordance with your wishes.

To be sure, what a heart attack victim wants or would want is often unknown. But we can overcome this ignorance by making available some simple cards or stickers through which people can communicate their choices ("please do / do not administer CPR in the event of a heart attack"). Still, many heart attack victims have no such information on them, and this problem cannot be wholly avoided. Doctors must therefore sometimes act under uncertainty. Here, I think, the burden of decision-making should not fall upon them. Society should give clear legal instruction to doctors about the "default": about how doctors should act absent special instructions from the patient. Such a default instruction is legitimate so long as each person is free to override it through an explicit personal instruction valid for himself or herself.

What if the state has not laid down any default instruction and no instruction can be found on the heart attack victim? Here I think you ought to administer CPR, simply because afterwards the patient has ways to end her life if she disagrees with your decision. By contrast, if you fail to administer CPR, contrary to what the patient actually would have wanted, the effect of your decision (her death) is final and beyond correction.