Ethics in HealthcareEvidence Based MedicineResuscitationSMACCDebate: ‘Do Not Resuscitate’ Should Be The Default

Debate: ‘Do Not Resuscitate’ Should Be The Default

Alex Psirides and Sara Gray debate over whether ‘Do Not Resuscitate’ (DNR) should be the default choice for all patients.

Alex contends that application of ‘CPR-for-all’ is the ultimate evidence drift.

A treatment that is completely appropriate for dropping dead whilst running a marathon has almost no place in acute healthcare facilities where chronic irreversible complex co-morbidities abound.

90% of doctors would not choose CPR for themselves, yet 100% are trained in how to administer it to patients.

Defaulting to ‘CPR-for-all’ removes a patients’ ability to provide informed consent for assault whilst they die from another disease.

Remember – 2 weeks in ICU can spare you 5 minutes of difficult conversation.

Sara on the other hand argues that DNR should not be the default position. Across the globe, patients are assumed to be full code to allow for prompt resuscitation, until code status can be discussed and clarified.

There are numerous excellent reasons for this.

Can you imagine if our systems decreed that DNR was the default? “Let’s not shock that VF, until we can clarify his code status.”

Or, “let’s not resuscitate that child, after all, DNR is the default and her mother isn’t here yet!”

Making DNR the default is not a good solution to ICU or hospital over-crowding.

Let’s not mandate DNR, let’s mandate having reasonable code discussions early and often.

Join Alex and Sara for a stimulating, engaging and entertaining debate!

For more like this, head to our podcast page. #CodaPodcast

Sara Gray

Sara Gray works in Toronto at St. Michael Hospital. She divides her work between Emergency Medicine, Critical Care, wellness programs, public speaking and professional coaching. But her real life revolves around her family, soccer, books, puzzles, sports, travel, friends, cocktails and food. Probably in that order.


Alex Psirides

Intensivist & optimistic dystopian. Emigrant son of an immigrant. Father of daughters.