Cardiopulmonary resuscitation for palliative care patients: a discussion of ethical issues

Willard, Carole

doi:10.1191/026921600676686023

Cited by 24 publications

(16 citation statements)

References 8 publications

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“…[4][5][6][7][8][9][10][11][12][13][14][15] The joint guidelines from the British Medical Association, Royal College of Nursing and Resuscitation Council (BMA/RCN/RC) have four underlying principles: 5 1 Timely support for patients and people close to them, and effective communication are essential. 2 Decisions must be based on the individual patient's circumstances and reviewed regularly.…”

Section: Professional Guidance and Guidelinesmentioning

confidence: 99%

A framework for making advance decisions on resuscitation

Regnard¹,

Randall

2005

Clinical Medicine

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-Decisions about cardiopulmonary resuscitation (CPR) continue to cause difficulties for healthcare professionals. Current UK guidelines provide information on the underlying principles, but do not include a clear decision framework. The resulting confusion about when and who to ask about CPR can result in an inappropriate burden being placed on patients, partners or families. A simple clinical decision framework is presented, together with the underlying principles. This framework is offered as an aid for clinicians and patients in understanding the current ethical, clinical and legal guidance on decisions about CPR. KEY WORDS: algorithm, cardiopulmonary resuscitation, clinical decisions, hospice care, learning disability, palliative care, terminal careCardiopulmonary resuscitation (CPR) is a lifeprolonging treatment, and decisions about CPR should be made according to the same principles and process as other life-prolonging treatments. Two important factors affect decisions about CPR at the time of the cardiorespiratory arrest. The first is that there is little time available for any deliberation since, if CPR is to be successful, it is imperative that it is started immediately. The second is that a collapsed patient lacks the capacity to consent to or refuse CPR. The combination of these two factors has led to the development of policies designed to make the decision about CPR in advance of the event. These are often referred to as deciding 'resuscitation status' or making a 'Do Not Attempt to Resuscitate (DNAR)' decision. The idea behind such policies is to make a CPR treatment decision when there is time for deliberation about the benefit, harms and risks of CPR, and to ascertain in advance whether the patient would wish to consent to or refuse CPR. When the patient is involved, the resulting decision is an 'advance decision' , sometimes also referred to as an 'advance statement,' 'advance directive' or 'living will' .Unfortunately, the apparently simple idea of making advance decisions regarding CPR has proved extremely difficult to implement in practice. There are several reasons for this difficulty.• There is a reluctance to appreciate that, as with other life-prolonging treatments, the justification for attempting resuscitation rests on a reasonable balance of benefit to harms and risks.• There is an obvious difficulty in making a decision about CPR treatment in advance of any knowledge about the clinical circumstances in which the future cardiorespiratory arrest will arise. This leaves professionals unable to ascertain the balance of benefit to harms and risks of CPR when the arrest occurs.• There is confusion about the role of the patient, partner or relatives in the decision.• There is a lack of appreciation by both patients and professionals that an advance decision about CPR should be implemented under the same principles, and ethical and legal guidance, as any other advance statement. Case examples illustrating confusion in clinical practiceA These case studies are based on true situations...

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Section: Professional Guidance and Guidelinesmentioning

confidence: 99%

A framework for making advance decisions on resuscitation

Regnard¹,

Randall

2005

Clinical Medicine

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“…The ability to extend and prolong life increases the ethical dilemmas in the complexity of clinical decision-making. Ethical dilemmas are likely to arise regarding the use of life-prolonging measures including cardiopulmonary resuscitation [16]. It has to be determined in case per case basis whether CPR is a futile medical treatment meaning thereby it cannot be expected to either restore the physiological cardiopulmonary functions or to achieve the expressed goals of the patient which may be an individual perspective.…”

Section: Cardiopulmonary Resuscitationmentioning

confidence: 99%

Ethical Analysis of Medical Futility in Cardiopulmonary Resuscitation

RK¹

2014

J Clinic Res Bioeth

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Cardiopulmonary Resuscitation (CPR) is a life-saving intervention in emergency medical care practiced globally for the last more than seven decades. It cannot be a solution to prevent every death and there are risks associated with this intervention. This article focuses on the ethical dilemmas related to the decisions of medical futility in cardiopulmonary resuscitation particularly in emergency settings. There are guidelines for the decisions to start and stop CPR but are mostly based on technical grounds only. Technically possible interventions are not always medically reasonable and all four principles of biomedical ethics -viz. respect for autonomy, beneficence, nonmaleficence and justice are associated with the issues of medical futility in this process. Autonomy deals with the issues of the individual right for CPR as well as the other side of the coin do-not-resuscitate (DNR) including death with dignity. The 'advance directive' and the need for surrogate consent are further dimensions of autonomy. As a life saving measure, beneficence comes into play while non-maleficence argues against performing CPR when the outcomes are harmful or futile. Futile interventions have to be avoided for the justice so that the precious intensive care units are not occupied waiting for the end-of-life. Literatures were reviewed and analyzed in the context of medical futility in CPR and the ethical dimensions of the issues have been explored. Ethical approach assists in deciding the futility of cardiopulmonary resuscitation in a given situation where the shared decision is taken by the medical professionals and the surrogates of the patients.

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“…In the last 30 years CPR has evolved from an intervention developed to treat the reversible precipitants of sudden death, indicated only in cases of acute insult to an otherwise healthy person, to a default measure employed in virtually all cases of death in hospital (Willard, 2000). Confusion exists, both in the minds of patients and doctors, between 'normal death' and cardio respiratory arrest.…”

Section: Expectations Of Cprmentioning

confidence: 99%

“…This practice can be contrasted with that found in the UK, where practices vary depending on the patient's situation. For example, in general, CPR is not carried out in hospices or at home, whereas DNAR decisions are routinely considered in general and oncology wards although they may not be discussed with the patient (Willard, 2000). Thus doctors in the UK are enabled to reduce the inappropriate use of resuscitation, but at the expense of patient autonomy (Mello and Jenkinson, 1998).…”

Section: Expectations Of Cprmentioning

confidence: 99%