Outcomes from cardiopulmonary resuscitation (CPR) remain distressingly poor. Overuse of CPR is attributable to unrealistic expectations, unintended consequences of existing policies and failure to honour patient refusal of CPR. We analyzed the CPR outcomes literature using the bioethical principles of beneficence, non-maleficence, autonomy and justice and developed a proposal for selective use of CPR. Beneficence supports use of CPR when most effective. Non-maleficence argues against performing CPR when the outcomes are harmful or usage inappropriate. Additionally, policies which usurp good clinical (...) judgment and moral responsibility, thereby contributing to inappropriate CPR usage, should be considered maleficent. Autonomy restricts CPR use when refused but cannot create a right to CPR. Justice requires that we define which medical interventions contribute sufficiently to health and happiness that they should be made universally available. This ordering is necessary whether one believes in the utilitarian standard or wishes medical care to be universally available on fairness grounds. Low-yield CPR fails justice criteria. Cardiopulmonary resuscitation should be performed when justified by the extensive outcomes literature; not performed when not desired by the patient or not indicated; and performed infrequently when relatively contraindicated. (shrink)

In Organ Transplants from Executed Prisoners, Louis Palmer proposes alleviating the urgent shortage of organs for transplantation by requiring condemned felons to donate their vital organs after execution. The book proceeds as follows. In his first chapter Palmer reviews the development of the quasi-property rights relating to the bodies of the dead, including the right to dispose of one's own body by means of a will and the right of relatives to bury it. In the second chapter, The Market for (...) Human Body Parts, he goes on to review the current American laws restricting the sale of body parts in order to show that death-sentence removal might be permissible within established principles of law. A C MacDonald has recently provided a good review of the legal restrictions …. (shrink)