The revised edition of Decisions Relating to Cardiopulmonary Resuscitation, issued this week, is designed to reflect developments in clinical practice and law regarding decisions about cardio-pulmonary resuscitation (CPR).
Key points emphasised in the new guidance include:
- the value of making anticipatory decisions about CPR as an integral part of good clinical practice
- the importance of involving people (or their representatives if they are unable to make decisions for themselves) in the decision-making process
- that when CPR has no realistic chance of success it is important to make decisions that are in the best interest of the patient, and not to delay a decision because a person is not well enough to have it explained to them or because their family or other representatives are not available
- the importance of careful documentation and effective communication of decisions about CPR.
The guidance also warns against adopting the ‘default position’ of providing CPR, as this potentially denies patients the opportunity to refuse treatment they may not want or that, for many, may not offer overall benefit.
‘Increased emphasis on communication’
Welcoming the revised guidance, Bill Noble, Marie Curie Medical Director, said: “It is encouraging that the guidance recognises the challenges of communicating Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions for healthcare professionals. This is particularly difficult where many healthcare teams are involved or where the patient lacks capacity to understand decisions.
“We welcome the increased emphasis on communication and advance care planning to place DNACPR decisions in the right context. This good practice guidance is welcome support for healthcare professionals to have more confidence in their ability to engage with patients and those close to them about the complex and emotive issues related to terminal illness.”
BMA medical ethics committee chair John Chisholm said: “It can be difficult to talk to patients or their family about the circumstances in which it may not be appropriate to attempt restarting someone’s heart. However, as doctors, it is our primary role to benefit patients and, when treatment can no longer achieve this, it is right to avoid invasive and burdensome interventions that will not be successful.
“The reality is that cardio-respiratory arrest is part of the final stage of dying. Although it is often portrayed on TV and film as a miraculous intervention that saves patients’ lives and reunites them with their loved ones, the truth is [CPR] carries the risk of internal fractures, ruptures, and long-term brain damage.
“Sadly, the survival rate is relatively low, and health professionals must be honest with their patients about the level of recovery that may be expected if CPR is attempted.
“These guidelines identify the key ethical and legal issues that should inform all CPR decisions. The basic principles are the same for all patients, in all settings, but differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis.”
The revised guidance can be downloaded from the website of the Resuscitation Council (UK)