In light of the SCC’s Cuthbertson v. Rasouli decision, the distinction between withdrawing and not offering a medical treatment is increasingly relevant. Because CPR is a “default” treatment for cardiac arrest, it requires a physician order to be withheld. However, the individual components of resuscitation that are clinically indicated are based on physician judgment and best practices. A physician who has assessed a patient and does not believe CPR to be clinically indicated can write an order to withhold from CPR without patient/SDM consent. This is an ethically defensible course of action and has been legally tested in Ontario. Institutions should word their advanced directives forms to make it clear that even if CPR is desired by a patient or SDM, the individual components of resuscitation to be used, if any, will be limited by what is clinically indicated rather than patient/SDM preference alone.

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