Summary

Principles

• Timely support for patients and people close to them, and effective, sensitive communication are essential.

• Decisions must be based on the individual patient's circumstances and reviewed regularly.

• Sensitive advance discussion should always be encouraged, but not forced.

• Information about CPR and the chances of a successful outcome needs to be realistic.

Practical matters

• Information about CPR policies should be displayed for patients and staff.

• Leaflets should be available for patients and people close to them explaining about CPR, how decisions are made and their involvement in decisions.

• Decisions about attempting CPR must be communicated effectively to relevant health professionals.

In emergencies

• If no advance decision has been made or is known, CPR should be attempted unless:

  • the patient has refused CPR;

  • the patient is clearly in the terminal phase of illness; or

  • the burdens of the treatment outweigh the benefits.

Advance decision making

• Competent patients should be involved in discussions about attempting CPR unless they indicate that they do not want to be.

• Where patients lack competence to participate, people close to them can be helpful in reflecting their views.

Legal issues

• Patients' rights under the Human Rights Act must be taken into account in decision making.

• Neither patients nor relatives can demand treatment which the health care team judges to be inappropriate, but all efforts will be made to accommodate wishes and preferences.

• In England, Wales and Northern Ireland relatives and people close to the patient are not entitled in law to take health care decisions for the patient.

• In Scotland, adults may appoint a health care proxy to give consent to medical treatment.

• Health professionals need to be aware of the law in relation to decision making for children and young people.

Introduction

Why policies are needed

Cardiopulmonary resuscitation (CPR) can be attempted on any person whose cardiac or respiratory functions cease. Failure of these functions is part of dying and thus …