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Ethics required medical staff to do CPR, even if policy didn't, bioethicist writes

Last week, 87-year-old Lorraine Bayless collapsed at Glenwood Gardens, an assisted living facility in Bakersfield, Calif., and later died.

While it’s not unexpected that an elderly person would die, what’s troubling is that after she collapsed, a nurse called 911, yet wouldn’t administer CPR or look for someone else to do it, despite the request of the emergency dispatcher. 

The management of Glenwood Gardens backed up the staffer’s decision to not start CPR. 

“Our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives,” Jeffrey Toomer, executive director of Glenwood Gardens, said in written statement. “That is the protocol we followed.”

Toomer was not the only one backing the decision not to start CPR. Bayless' daughter told a reporter for KGET, the NBC affiliate in Bakersfield, that she was also a nurse and was satisfied with the care her mother received. It seems unlikely that a lawsuit will follow.

So why might the staffer and the facility balk at using CPR to try to save the life of a dying woman? One reason is that the woman who called 911 may not have felt comfortable trying CPR for some reason or perhaps felt out of practice. Another might be that since the facility had a call and wait policy, perhaps she worried for her job. One possible reason for Glenwood Garden’s policy is that there is always a nagging worry that no good deed will go unpunished — if CPR is given but it is done improperly will there be liability for the assisted living facility. As it happens, none of these reasons are good ones not to try CPR.

Even without training someone might be able to help if guided by a knowledgeable person. The dispatcher offered to walk the caller through what to do but the caller still declined.  And liability is not really much of a worry unless you do something extremely absurd every state shields those who try to be Good Samaritans against lawsuits.

It is true that CPR does not work as well as we might wish. Even when someone sees a heart attack happen or a patient collapse, as was true in this case, the odds of preventing death in someone that age are not great.

Still, I can’t help thinking that unless there is some medical fact about the patient that we don’t know—she had terminal cancer or a Do Not Resuscitate request in place —there is no ethical justification for calling 911 and then waiting until they come before starting CPR. Anyone of us could be confronted with this choice. 

Every one of us should think hard about what we ought to do when someone needs our help to live.

Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

Related story:

Policy questioned after nurse refuses to do CPR