CPR for patients in a persistent vegetative state?
CMAJ 1998;159:18
See response from: C. Weijer
Dr. Weijer argues that an ethical analysis favours a family's right to request CPR for a 65-year-old patient in a PVS with no hope of recovery. He thinks this request should be honoured in Canadian hospitals and, implicitly, that the costs should be borne publicly.
Even if there was enough public money to cover these costs, I am not persuaded that the proposed intervention would be more appropriate than many others, some of which might also prolong life. Moreover, in today's world there will be no increase in spending, and the proposed expenditures on patients in a PVS would lead to reduced spending on other patients. I am not convinced that the redeployment of resources to support the cost of CPR in these cases would be favoured by most Canadians over any present health expenditure. Until society decides to the contrary, there are no compelling ethical, moral or legal arguments favouring the preferential allocation of resources to support the cost of CPR in these cases.
We are used to special interest groups requesting increased support, and we interpret such requests accordingly. However, to promote one intervention on ethical grounds must surely impose an ethical responsibility to consider the ramifications on others. This aspect seems to have been neglected in Weijer's analysis.
John Turnbull, MD
Division of Neurology
Department of Medicine
McMaster University
Hamilton, Ont.
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