I appreciate Dr Pope’s thoughtful comments about my “indecent proposal.”1 I fully agree thatmaking an actual change to the current default status of full attempts to resuscitate in every instance of cardiac arrest will indeed be “difficult to operationalize.” However, I think the primary difficulty is in challenging the very deep-seated reluctance among health professionals to recognize the limits of technology and to engage in meaningful discussionswith patients and families about goals of care and judgments about effective vs ineffective interventions.

The challenge of determining what constitutes a meaningful chance of success of CPR is no different than the task of every clinician whomust decide when and if a high-risk procedure in life-threatening conditions should be recommended or even offered. Clinicians accomplish this every day, with varying degrees of certainty and comfort.

I do want to clarify that I do not propose“exempting” any patients from this proposal. Rather, the...

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