Cardiopulmonary Resuscitation

To the Editor. —La Puma et al¹ suggest substituting no emergency CPR [cardiopulmonary resuscitation] for the term DNR [do not resuscitate] to avoid confusion. They come closer to addressing the confusion by stating that "physicians and patients should decide... about medical and surgical therapies that may be appropriate...." This could be more clearly stated: It is normally necessary to obtain informed consent to ethically initiate or continue any treatment, including CPR, mechanical ventilation, or vasopressors. If the possibility that these treatments will be medically indicated is reasonably foreseeable, then consent should be sought prior to an emergent situation. For example, consent for coronary artery bypass surgery is sought from patients who are scheduled for percutaneous transluminal angioplasty and, similarly, consent for CPR and other treatments should be sought in high-risk patients whether or not they are terminally ill, since patients may legitimately consent for some treatments, perhaps hemodialysis, but