Tuesday, June 16, 2015

A Right to Be Shocked?

Back in the 18th century, concerned citizens were experimenting with ways to bring back the dead. But they didn’t make a lot of progress. Indeed, the 19th century was not a particularly productive one for the science of resuscitation, and the first part of the 20th century wasn’t much better.

Fortunately, though, there were other important advances during that period, including many new discoveries and inventions. There was the airplane, of course (1903), and the ballpoint pen (1935), and let’s not forget the machine that makes sliced bread (1927), as well as the first Rock & Roll song (1951). That, by the way, is widely believed to be “Rocket 88”, by Jackie Brenston and his Delta Cats, which beats the heck out of Schubert or Chopin, if you ask me.

But if you were a cardiac arrest victim who was “apparently dead” in 1951, your chances of survival probably weren’t much better than they would have been 100 years before. On the bright side, if you were lucky enough rejoin the living in 1951, you’d be able to wake up to the world’s first Rock and Roll song.

Things Have Changed

In the last 50 years, things have changed. A lot. Now resuscitation is no longer the province of medical professionals. Anyone can resuscitate anyone. Moreover, it’s a revolution that we’re all part of, whether we know it or not. If you have two arms, and a sense of rhythm, you can perform CPR.

That’s not such a bad thing. Certainly the science of resuscitation has improved, and CPR does save lives. So encouraging bystanders to try their hand at bringing back the dead seems reasonable.

On the other hand, a try at resuscitation seems to have become mandatory. It’s the new default. Unless you happen to have an “out of hospital” Do Not Resuscitate (DNR) order, or a highly visible bracelet (or a tattoo), if your heart stops there’s a good chance that someone is going to feel compelled “to do…. something!”

That’s a little worrisome. I’m thinking of the court case that resulted from the death of Mary Ann Verdugo, who died in a Target store in 2008. Her family brought a lawsuit against Target because, they said, the store did not have an Automatic External Defibrillator (AED) available to its customers. That case is making its way slowly through the courts. In the most recent development, the California Supreme Court found in favor of the store, saying that it didn’t have a duty to provide defibrillators. The case isn’t over, though. Now it goes to the 9th Federal Circuit Court.

Crowdsourcing Resurrection

Regardless of how that suit is decided, it’s going to have interesting implications for the ongoing revolution in crowdsourcing resurrection. It also will raise many questions that we’ll need to think through very carefully.

Do we all have an obligation to try to bring someone back from the dead?  Should we assume that person lying on the floor wants us to try? How much evidence to the contrary do we need in order to decide that resurrection shouldn’t be an option?

These are difficult - and perhaps impossible - questions for the paramedics, doctors and nurses in medical settings who wrestle with them every day. And that’s concerning, because now we’re asking everyone to make those decisions. Bystanders, resident service directors and even gardeners will need to start thinking about whether and when resurrection is appropriate, necessary and the right thing to do.

These difficult questions are multiplying, as the revolution in crowdsourcing resurrection is speeding up. It took 200 years to get the hang of CPR. Now we have defibrillators that are proliferating in malls and airplanes and bus stations. And there are more developments on the horizon.

Sure, we’ll get better at bringing back the dead. That’s good news for people who can rejoin the living, and especially for those who want to. But as the tools of crowdsourcing are increasingly available, we need to figure out whether and how to use them.

By David Casarett, MD

Dr. Casarett, a researcher and tenured professor at the University of Pennsylvania Perelman School of Medicine, will present the 21st Annual Rosemary Flanigan Lecture on August 12, 2015.


Anonymous Anonymous said...

Not only are survival rates abysmally low, those who survive are at considerable risk of being neurologically impaired. So far, empirical studies that document this procedure have avoided the obvious outcome measure: what do the survivors, including the neurologically impaired, think about CPR. Our own empirical studies of the impact of ethics consultations on ICU patients included this kind of outcome measure, namely patient satisfaction. I think more researchers should do so before they trumpet the success of attempting CPR.
Lawrence J. Schneiderman, M.D.
Emeritus Professor,
Family Medicine and Public Health,
UCSD School of Medicine

Friday, June 19, 2015  
Anonymous Medobserverships said...

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Tuesday, July 21, 2015  

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