On Cardiopulmonary Resuscitation of the Elderly
CPR of the Elderly
To the editor:
First of all, you will find enclosed a check for $50.00 to cover a subscription to the English bi-annual Journal ASSIA-Jewish Medical Ethics and the Hebrew quarterly ASSIA.
Secondly, I am asking for your help. In the United States, the debate over Cardiopulmonary Resuscitation of the Elderly has moved from being an ethical question to being a medical question. Physicians are challenging the efficacy of Cardiopulmonary Resuscitation, claiming a low success rate for elderly people. As a Jewish Ethicist whose values are informed by the Halacha, I feel that this is just another rationalization for rationing medical care to the elderly. Please point me to literature you may be aware of concerning successful use of Cardiopulmonary Resuscitation on the elderly population. If said literature is not easily available in the United states, please send it to me. It is a mitzvah!
I am looking forward to hearing from you.
Shalom,
Rabbi Louis J. Feldman, Ph.D.
Reseda, California, USA
Editor’s Response:
כט מנ”א תשמ”ח
August 12, 1988
Dear Rabbi Feldman שליט"א,
Rabbi Dr. M. Halperin שליט"א passed on your letter to me yesterday and I am hastening to reply. Regarding the problem of Cardiopulmonary Resuscitation in the elderly, I cannot agree with you more that “this is just another rationalization for rationing medical care to the elderly.” I do not know of any published figures comparing the efficacy of CPR in the “elderly” and the “young,” but it seems logical to assume that the results in the elderly will be poorer. This, because of the general organ disease or failure that is already present before the patient reaches the stage of cardiac or pulmonary arrest. In patients admitted to intensive care units, the unfavorable effect of increasing age on ICU survival is well documented (Campion et al., JAMA 246:2052, 1981). In a survey conducted by one of our residents here (unpublished), 54% of patients admitted to our ICU were older than 65 years. The mean age of 52 of 126 patients who survived for 6 months was 54 years with a range of 15-102 years. The mean age of the entire group was 60 years.
However, halachically, age, per se, has no bearing whatsoever on the obligation to treat and to resuscitate. I have just completed an article on the subject of Euthanasia which is published in this issue of JME. May I also refer you to an authoritative פסק by הגרש"ז אוירבעך שליט"א in הלכה ורפואה ג עמ' ס and to my book נשמת אברהם חיו"ד עמ' רמד.
I do hope this answers your query.
כתיבה וחתימה טובה
Yours sincerely,
Professor A.S. Abraham, MD, FRCP
Director, Department of Medicine B
Source: ASSIA – Jewish Medical Ethics,
Vol. I, No. 2, May 1989, p. 56