In the February 20, 2008, issue of the Journal of the American Medical Association, Peberdy and associates1 reported an analysis of probabilities of survival from in-hospital cardiac arrest. Although their purpose was to examine whether outcomes differed according to the time and day of the week when the arrest occurred, their data raise other important questions about use of cardiopulmonary resuscitation (CPR). The current norm in acute care facilities is to assume that CPR should be performed in every case of cardiac arrest, unless a specific physician order to the contrary is in place. In this column, I propose a reversal of this; that is, I propose that in every case of cardiac arrest, unless a specific physician order to the contrary is in place, CPR should be withheld.

This proposal rests on well-established principles of bioethics, professional norms, and data about the effectiveness of in-hospital CPR. To begin...

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