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(Circulation. 1998;98:619-622.)
© 1998 American Heart Association, Inc.

Editorials

Rites and Responsibility for Resuscitation in Heart Failure

Tread Gently on the Thin Places

Lynne Warner Stevenson, MD

From the Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Lynne Warner Stevenson, MD, Brigham and Women's Hospital/Cardiovascular Division, 75 Francis St, Boston, MA 02115.

Key Words: heart failure • resuscitation • death, sudden • Editorials

In Celtic mythology, there are pieces of ground considered to be "thin places" where the measured world comes closest to the infinite. Such places may have been set apart for burial grounds and other ritual sites. The Celtic phrase describing them derives from the Latin limen, a threshold or frontier where 2 countries meet (the root of "subliminal").¹ As physicians, we bear the privilege of escorting patients and families over the thin places. Krumholz and his colleagues² have ventured to this border to provide valuable information as we ponder our responsibilities there.

Rights of Resuscitation

Once considered to be heroic, resuscitation has become routine. Communities are trained in CPR, defibrillators are on hand at many sporting events, and paramedics provide full advanced cardiac life support services in the home. The majority of patients admitted to hospitals seek survival, regardless of the severity of chronic illness. In 1 study, 90% of hospitalized patients expressed preference for resuscitation if their admission level of function could subsequently be restored.³ Of patients older than 55 years who had been discharged after an intensive care unit stay, 74% were certain that they would undergo another intensive care unit stay to prolong survival for as little as 1 month of additional life.⁴ In the current study, only 23% of patients stated that they did not wish resuscitation, and 40% of such patients subsequently changed their minds in favor of resuscitation.

As patients live longer with chronic illness, death offers a welcome end to suffering for some, who should . . . [Full Text of this Article]

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