IN THIS issue of the Archives, Jecker and Schneiderman1 criticize the strictness of the American Heart Association (Guidelines) for withholding (and withdrawing) prehospital cardiopulmonary resuscitation (CPR)1 and to this position we take strong exception.
The purpose of an emergency medical services (EMS) system is to save lives that otherwise would be lost and to reduce morbidity and pain. Each EMS system is under continuous supervision by medical professionals to assure that these goals are met. Criteria for decision making must be as clear and objective as possible and the system must be able to demonstrate accountability at every level. A high level of ethical performance is expected. A wide range of legal obligations exist, including the implied consent of the unresponsive or incompetent patient to life-saving and life-prolonging treatment in the absence of credible information to the contrary. The withholding of such care on an arbitrary or impressionistic