In Reply. —We thank Grundler for his contribution, and the many other physicians who have corresponded with us about our study.
Thinking of cardiopulmonary resuscitation (CPR) as a therapy is exactly right. Cardiopulmonary resuscitation is a minimally effective therapy for cardiopulmonary arrest. In-hospital CPR is successful in reviving patients to leave the hospital in approximately 14% of resuscitation attempts.1
A major difference between CPR and other therapies is that CPR is used automatically in the hospital. No physician's order is required. It is the only therapy that a physician must write an order to avoid.
Two indications exist for "No Emergency CPR" orders: (1) patient wishes, and (2) medical futility. Discussions about emergency CPR and about other therapies are best initiated by the physician and carried on in the office. Physicians should offer a balanced, compassionate, and intelligible explanation of the benefits and burdens of life-sustaining treatments to elderly