What's the Harm in Cardiopulmonary Resuscitation?

This article examines the ethical complexities surrounding the use of cardiopulmonary resuscitation (CPR) in clinical settings, focusing on the philosophical concept of harm as central to decision-making. It critiques the dominant Counterfactual Comparative Account (CCA) of harm—which defines harm as making a patient worse off than they would have been otherwise—by highlighting three key challenges: preemptive harms, the harm of death, and the distinction between experiential and non-experiential harms. These challenges contribute to differing interpretations of harm among clinicians, patients, and families, complicating CPR decisions, especially when patient wishes are unknown. The article advocates for pluralistic conversations that acknowledge diverse understandings of harm and recommends incorporating harm-independent ethical principles, such as respect for human dignity and precedent autonomy, to better guide clinical ethics and alleviate moral distress. It further suggests that these insights extend to other critical care decisions, including the use and limitation of life-sustaining treatments.