Is it always wrong to perform futile CPR?
That’s the question noted ethicist (and pediatric intensivist) Robert Truog asks in a recent opinion piece in the New England Journal of Medicine. And it’s a good question, one that any experienced intensivist has probably asked themselves more than a few times during their career. (Although the journal gives free access to most of their opinion pieces, for some reason they didn’t with this one. So the link is to an extract, but but if anybody wants a full copy, let me know.)
I’ve written before (also in reference to an article by Dr. Truog) about the ethics of futile care — that is, care that is of no benefit to the patient. As a matter of principle, physicians are not obligated to provide such care. The question typically arises when a family asks us to use a potentially toxic or painful treatment in a situation in which a child has no chance (in the opinion of the doctors) of recovering. These are not uncommon situations; I’ve written real-life descriptions of a couple of them in one of my books. Yet even though we’re not obligated to do it, are there times when an attempt to resuscitate a terminally ill child is ethical, even necessary?
Dr. Truog thinks there are such times. Some families simply cannot accept, even after long, painful discussions, that their child will not survive. They cannot “give up,” which is how they may see a decision not to attempt CPR. Like Dr. Truog, I’ve cared for a few patients and their families like that. And, like Dr. Truog, I’ve done CPR on such children. I haven’t prolonged it, but I’ve done it, with the parents looking on, sufficiently long to demonstrate its futility. And the families appreciated that I had done it.
I suppose you could say that when I did that I was treating the family, not the patient. More extreme critics might say I was wasting resources or even being disrespectful of the newly dead. Yet there certainly are times, when their child is beyond saving, that it is appropriate to treat the family in this way. I think any intensivist who doesn’t understand that probably hasn’t practiced pediatric critical care long enough yet.