Discussing cardiopulmonary resuscitation with elderly rehabilitation patients. Ethical and clinical considerations toward the formation of policy.

Abstract

Studies have demonstrated that most elderly persons who undergo cardiopulmonary resuscitation do not survive to hospital discharge. Because resuscitation efforts among elderly patients may fail either to restore hemodynamic stability or the patient's prearrest functional levels, ethical arguments as well as regulatory standards have urged the involvement of patients and their families in deciding about the advisedness of cardiopulmonary resuscitation. This article examines various ethical dimensions of conducting do-not-resuscitate discussions with competent, elderly persons in acute rehabilitation environments. Viewpoints that seek to excuse or resist do not resuscitate discussions among elderly rehabilitation consumers will be discussed as well as programmatic or psychological factors that appear to bolster such positions. These arguments, however, will be shown to be inferior to others that urge rehabilitation providers to engage their patients in frank and sincere discussions regarding their resuscitation status in the event of arrest.