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Betting on CPR: a modern version of Pascal’s Wager
  1. David Y Harari1,
  2. Robert C Macauley2
  1. 1Dept. of Psychiatry, University of Vermont Medical Center, Burlington, Vermont, USA
  2. 2Dept. of Pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
  1. Correspondence to Dr David Y Harari; DavidHarari.MD{at}gmail.com

Abstract

Many patients believe that cardiopulmonary resuscitation (CPR) is more likely to be successful than it really is in clinical practice. Even when working with accurate information, some nevertheless remain resolute in demanding maximal treatment. They maintain that even if survival after cardiac arrest with CPR is extremely low, the fact remains that it is still greater than the probability of survival after cardiac arrest without CPR (ie, zero). Without realising it, this line of reasoning is strikingly similar to Pascal’s Wager, a Renaissance-era argument for accepting the proposition for God’s existence. But while the original argument is quite logical—if not universally compelling—the modern variant makes several erroneous assumptions. The authors here present a case of a patient who unwittingly appeals to Pascal’s Wager to explain his request for maximal treatment, in order to highlight the crucial divergences from the original Wager. In understanding the faulty assumptions inherent in the application of Pascal’s Wager to code status decisions—and identifying the underlying motivations which the Wager serves to confirm—providers can better ensure that the true values and preferences of patients are upheld.

  • CPR
  • DNR
  • code status
  • Pascal’s Wager
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Footnotes

  • Contributors Both authors (DYH and RCM) contributed to development of this manuscript, including but not limited to the drafting, writing, organising, editing, revising and editing process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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