EDITOR, - The editorial and papers on decisions regarding cardiopulmonary resuscitation show the importance of involving patients and establishing written policies.*RF 1-3* We agree with these authors' conclusions but would sound a cautionary note.

Some months ago we instituted a policy whereby mentally competent patients admitted to the unit were routinely asked whether they would want cardiopulmonary resuscitation. Our experience was similar to that described by Morgan and colleagues,3 with most patients welcoming being involved and wishing to express an opinion. However, on one occasion a relative took exception to the practice and contacted her MP and the local press and television. We were then both accused of running a covert euthanasia policy and attempting to withdraw treatment from elderly patients in order to save money. In the furore that followed we saw how the issue of withholding cardiopulmonary resuscitation is easily confused by the lay public with euthanasia.

While it must be ethically right that patients are involved in these decisions, great care needs to be taken in how their views are ascertained. Who asks patients, when and how they are asked, and which patients are excluded? Is the patient's view always binding, or is it to be considered as part of the overall decision making process? These are all vital questions to address when setting up such a policy. Unfortunately, in practice, it is often easier to avoid these difficult and complex issues - to continue with tradition and let the doctor decide.