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Editorials: POINT/COUNTERPOINT EDITORIALS |

Counterpoint: Is It Ethical To Order “Do Not Resuscitate” Without Patient Consent?

Constantine A. Manthous, MD, FCCP
Author and Funding Information

Affiliations: Bridgeport, CT ,  Dr. Manthous is Associate Clinical Professor of Medicine, Yale University School of Medicine and Bridgeport Hospital.

Correspondence to: Constantine A. Manthous, MD, FCCP, Associate Clinical Professor of Medicine, Yale University School of Medicine and Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610; e-mail: Pcmant@bpthosp.org



Chest. 2007;132(3):751-754. doi:10.1378/chest.07-0912
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While beneficence, nonmalfeasance, and justice are cornerstones of medical bioethics,1 respect of patient autonomy is arguably the ascendant ethical principle of American medicine. A preponderance of patients believe they should consent to health-care interventions,23 and > 90% of patients wish to choose or reject CPR during hospitalization.3 Even though it is most often ineffective, CPR is the only medical intervention that may affect the outcome of cardiopulmonary arrest. Respect of autonomy requires that, when possible, patients have the opportunity to choose even the nature of their deaths (ie, with or without CPR, understanding its risks and benefits). Accordingly, I will argue that, in 2007 America, it is unethical for physicians acting alone to withhold CPR without seeking the consent of the patient or proxy (unilateral do not resuscitate [DNR]). However, it is not categorically unethical to withhold CPR without consent if, in the future, a just process is created, ratified by society, and actuated.

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