The man was 45 years old and dying of liver failure. In an encephalopathic coma and on three vasopressors to maintain a blood pressure of 70 mm Hg, he had progressive renal insufficiency despite hydration and required intubation. Several times his wife was asked whether he should have do-not-resuscitate (DNR) status. Each time she reflected, then tearfully said that the team should "do everything"—and so they did. I made rounds with his team in the intensive care unit one day, and as we discussed the hopelessness of his situation in conference his pressure dropped. The attending physician in the unit was preparing to perform cardiopulmonary resuscitation (CPR) when I talked him out of it.

The resident and I convinced the attending physician—a caring and competent man—that CPR for this patient was medically and morally wrong. I argued that a request to "do everything" should not apply to a procedure without medical indication. But here's the rub: CPR differs from other procedures (even life-saving ones); it is a right that must be specifically declined. This patient was not offered a liver transplantation or hemodialysis because at this stage they are virtually futile and therefore are not legitimate options, although either would almost certainly have extended his life longer than would CPR. Yet his wife was asked whether he was to be denied CPR, implying legitimacy in doing it. For her, this false "choice" was a cruel hoax, suggesting some chance of meaningful survival when there was none and leaving her saddled with an irrelevant "decision" to let her husband die. The price of this overly magnified regard for autonomy when considering CPR is suffering for her, for her husband, and for the physician's morale.

It is true that we cannot know with certainty the course that a disease will take; however, physicians use probabilities too often to feign ignorance of their meaning. I ask my colleagues: Can the suffering that arises from considering CPR differently than other treatments and perfunctorily doing it on a request to "do everything" possibly be worth the benefit to so few?