First and foremost, I would like to thank Dr.Conboy for giving this talk and sharing her insights on cardiopulmonary resuscitation (CPR) vs Do not resuscitate (DNR). I believe many people have misconceptions about CPR as it is frequently shown on medical television shows, where CPR is performed on the patient and the patient wakes up afterwards. There is a disconnect of what CPR does to the body other than bring back patient’s beating heart. As Dr. Conboy mentioned, CPR can cause irreparable damages such as rib fractures, sternum fractures, and lung damages that may require the insertion of a breathing tube. These potential complications will do more harm than good which goes against the two of the main ethical principles, non-maleficence, and beneficence. Beneficence refers to promoting the well-being of others while non-maleficence refers to avoid harming or injuring others. Therefore, I can understand Dr. Conboy’s proposal of reversing the default rule in hospital to holding off resuscitation until somebody has provided informed consent. Although I can see the good intention behind the Dr. Conboy’s proposal and reasoning, I would like to argue against this proposal and offer a different approach. I disagree with Dr. Conboy’s proposal because it would go against the moral obligation of do no harm by spending time on getting informed consent from family members or medical proxies while watching the patient die when we can perform CPR. According to the current CPR statistics, there are about 750,000 CPR attempts in US hospitals, with about a 20 percent survival rate. Although the survival rate is only 20%, that is 20% more than not doing CPR. I would like to argue that a better approach is to focus on educating patients about code status, the risks and benefits of CPR vs DNRs, and what really happens during CPR. This can be done by primary care physicians during an annual exam so that it can be recorded in the patient’s chart. This would allow patient to have time to consider all the pros and cons in order to make an informed decision.

I enjoyed this discussion on a controversial topic! She mentioned the importance of timing, and quality of having the conversation with the patient something that is often not thought about when discussing this issue. I was surprised with her example when the nurse said, "you do want us to start your heart back up if necessary right?" But the patient in this scenario did not fully understand the meaning of this question, so of course she would say yes. So every patient does indeed have a right to know exactly what that would entail to be resuscitated. I hadn't previously considered the fact that CPR often injures patients; in the thought-provoking example the speaker used regarding the gentleman dying in severe pain due to being saved from CPR and a cracked sternum. I strongly believe a patient's wishes should always be taken into consideration; and I stand with this speaker in that each patient should be able to say no to CPR. What a wonderful discussion about patient's rights and informed consent, I enjoyed this talk.

Dr. Conboy makes a small detail side comment but brings up a big point. Although it is an accepted rule in the hospital to perform CPR unless someone has DNR, they will perform it. But what if it is a new employee or an employee who has not worked in a unit of the hospital before that typically sees super sick people, will everyone react the same to the event? Having an experienced nurse confidently ask “would you like CPR in the case that your heart stops?” is very much different than the new nurse who has never confidently asked this question. Even more so - is the tone someone could use. Dr. Conboy explains the example of her mother and how the nurse in her tone and the words she used to ask her mother “you want to be resuscitated right?”, assumptions in medicine are dangerous, and not only that, this is not respecting a patient’s autonomy. In another setting, asking someone about CPR in that way could sound like it is a suggestion and could be pressuring a patient into medical decisions that may not be best for them. When Dr. Conboy stated it may be more ethical to actually not perform CPR unless a patient is given the consent to do so, she is absolutely hitting an important ethical principle - to do no harm. To do no harm means far more than just the physical act of harming someone. This could very much emotionally and mentally change someone, especially their loved ones around them. Someone may be better off not being resuscitated because CPR would then cause more harm like a cracked chest. If a patient knew CPR may be doing more harm than good for their own body they may not want to go through with it - so it should be normal to say you don’t want it by not signing an informed consent. This could be dangerous if used in a place like a pediatric hospital or an ER but Dr. Conboy makes it apparent that this would be very applicable to individuals who are in their older stages of life or their bodies would break because of it. Hospitals, by following the rule to do CPR unless otherwise stated DNR, could very well be misinforming the patient since it is the norm, when a patient would later realize they would have a very low quality of life if resuscitated. This does not even scratch the surface of the financial burden this could cause as well if someone were resuscitated then needing to be on machines the rest of their life. Should this also apply to premature infants who may also experience a low quality of life after CPR?

I respect Dr. Conboy’s courage to debate such a controversial topic. They mention how our current medical practices perform cardiopulmonary resuscitation (CPR) as a default practice in comparison to the other alternative of not performing these resuscitative measures. The idea is proposed of reversing this default rule in the hospital so that CPR is not to be performed unless informed consent is given. This is clarified to mention that this does not apply to the emergency department setting; however, I do not agree that this is the solution to the problem. As they explained, healthcare workers are to follow the ethical principles of to do no harm, to do good, be fair, be truthful, and to allow patient autonomy. If we are to reverse this default procedure, I disagree and believe that this will in fact not hold up our moral obligations as health care workers. The success rate of a procedure is of diminished importance when the cost is someone’s life. I propose that we keep the default to CPR; however, there should be a stronger push by all physicians, including primary care physicians, to talk with patients about their wishes starting at early ages and get informed consent.

According to Dr. Conboy, a hospital should not default to performing CPR on coding patients because she believes it violates the ethical principle of “do no harm.” As we all know, in the absence of a DNR we perform CPR in the hospital. She describes going to the hospital with her mom when a nurse asked “you do want us to start your heart back up when it stops don’t you?” I do think there is a correct way to ask a patient if they want CPR or if that would like to have DNR as their status. This nurse asked her mom in a suggestive way, implying there is only one correct answer to this question instead of allowing the mother to make her own decision. Patient autonomy should be provided through a discussion between the healthcare provide and patient about the benefits and risks of CPR. According to Dr. Conboy CPR shouldn’t occur until someone has provided informed consent. However, what do we do in the case of an emergent trauma where the patient is unable to provide consent? Is it her idea that we just allow them to pass away as the default? Success rate is 40% according to Dr. Conboy and only 10-11% from this amount are discharged from the hospital. Even with these low statistics, it is hard to imagine a world where the default is instead DNR. I do agree with Dr. Conboy that we should discuss code status more in depth. However, taking it out all together as the first step when someone is admitted to the hospital is what I disagree with. My argument against Dr. Conboy only using the ethical principle do no harm to decide if we should use CPR is the argument of the ethical principle of beneficence. According to this ethical principle, a physician should always act in a way that benefits the patient, which could be to help them continue their life if they want through CPR. Just like most issues in medical ethics, there is no one correct answer.