Bioethics Blogs

CPR and Ventricular Assist Devices: The Challenge of Prolonging Life Without Guaranteeing Health

by David Magnus and Danton Char

The woods decay, the woods decay and fall,
The vapours weep their burthen to the ground,
Man comes and tills the field and lies beneath,
And after many a summer dies the swan.
Me only cruel immortality
Consumes: I wither slowly in thine arms
 (Alfred, Lord Tennyson “Tithonus” lines 1–6)

It’s fitting that the ethical challenges raised in this, our Valentine’s Day issue, resonate in a mythic love story. Eos, titan of the dawn, fell in love with a mortal man, Tithonus. Because she could not bear to lose him, she pleaded with Zeus to grant him immortal life but forgot to ask for immortal youth, so he withered, unable to die but too fragile to live. Like Eos, our two target articles suggest that the current application of two heroic cardiac interventions, the widespread use of cardiopulmonary resuscitation (CPR) and the implantation of ventricular assist devices (VAD) in patients with end-stage heart failure, may reflect a medical ethos too enamored of preserving life without giving enough mindfulness to the burden on patients and families of survivorship in a debilitated or devastated state. How do we appropriately prolong life and health, while guarding against making Eos’ mistake?

By many accounts the widespread introduction of CPR is a public health success story. In the 110 years since George Crile first successfully used closed chest compressions on a patient in surgery and demonstrated their efficacy in dogs, CPR has been standardized, has been taught to millions of health care providers and regular citizens, and systems have been put in place to track CPR outcomes and initiate data-recommended improvements.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.