To the Editor: Most nursing home residents are frail.1"3 Cardiopulmonary resuscitation (CPR), when provided without forethought to frail elderly, may cause unintended consequences worse than death, harming the patient, family, care workers involved, arid society in general. For the patient, a form of physical discomfort occurs from possible rib and sternal fractures during chest compressions. Patient survival from CPR may lead to unacceptable quality of life, such as a vegetative form, resulting in undignified delay in death. Families experience unfulfilled hope, cost of lost earnings while at bedside, and cost of supporting a disabled survivor. Health care workers involved have to deal with frustration, sadness from lack of success, and guilt for inflicting harm to the patient. In most resuscitations provided to frail elderly, health care providers are fighting their own uncertainties to the basic questions, are we doing the right thing or should we be doing anything at all except providing comfort care? For society, there is this burden of escalating health care cost and resource consumption that, because of emotional, religious, and political repercussions, no one wants to talk about. The question comes down to who should not be resuscitated and how to change society's perception about CPR?
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