BMJ  2003;327:614-615 (13 September), doi:10.1136/bmj.327.7415.614

Education and debate

For and against

Doctors should not discuss resuscitation with terminally ill patients

FOR

Charlotte Manisty, senior house officer1, Jonathan Waxman, professor of oncology1

1 Department of Cancer Medicine, Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Campus, London W12 0NN

Correspondence to: J Waxman j.waxman@ic.ac.uk

Doctors in Britain are expected to attempt resuscitation unless patients have agreed do not resuscitate orders. If patients are terminally ill, is discussion of such orders harmful or helpful?

The first 150 words of the full text of this article appear below.

Patients increasingly want to participate in decisions about their medical treatment. Although this is appropriate in most circumstances, discussing cardiopulmonary resuscitation with terminally ill patients is not practical, sensible, or in the patient's best interests. In these special situations, patient involvement is tokenism and entirely of negative value.

The UK guidelines on cardiopulmonary resuscitation require doctors to attempt resuscitation in all patients who have a cardiac or respiratory arrest unless a do not resuscitate order exists.1 Doctors are required to discuss the value of resuscitation with their patients before making a do not resuscitate order (box). However, discussion about cardiopulmonary resuscitation forces the patient to confront the inevitability of their fate, with negative consequences. Patients need to maintain some hope—if not for a cure then at least for some comfort. It is not appropriate that all comfort is lost as a result of the inappropriate blanket application of a facile . . . [Full text of this article]

-->
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Article

Doctors should not discuss resuscitation with terminally ill patients: AGAINST
Irene J Higginson
BMJ 2003 327: 615-616. [Extract] [Full Text]

This article has been cited by other articles:

  • Johnson, H., Nelson, A (2008). The acceptability of an information leaflet explaining cardiopulmonary resuscitation policy in the hospice setting: a qualitative study exploring patients' views. Palliat Med 22: 647-652 [Abstract]  
  • Wilson, J (2008). To what extent should older patients be included in decisions regarding their resuscitation status?. J. Med. Ethics 34: 353-356 [Abstract] [Full text]  
  • Kelly, J. (2008). Nurses' and Doctors' Perspectives on Slow Codes. Nurs Ethics 15: 110-120 [Abstract]  
  • Ackroyd, R., Russon, L., Newell, R. (2007). Views of oncology patients, their relatives and oncologists on cardiopulmonary resuscitation (CPR): questionnaire-based study. Palliat Med 21: 139-144 [Abstract]  
  • Harris, D., Davies, R. (2007). An audit of "do not attempt resuscitation" decisions in two district general hospitals: do current guidelines need changing?. Postgrad. Med. J. 83: 137-140 [Abstract] [Full text]  
  • Harkness, M., Wanklyn, P. (2006). Cardiopulmonary resuscitation: capacity, discussion and documentation. QJM 99: 683-690 [Abstract] [Full text]  
  • Schildmann, J, Doyal, L, Cushing, A, Vollmann, J (2006). Decisions at the end of life: an empirical study on the involvement, legal understanding and ethical views of preregistration house officers.. J. Med. Ethics 32: 567-570 [Abstract] [Full text]  
  • (2003). Hit Parade. BMJ 327: 1234-1234 [Full text]  

Rapid Responses:

Read all Rapid Responses

Hope and confort come from full disclosure
Richard A Simcock
bmj.com, 12 Sep 2003 [Full text]
Re Doctors should not discuss resuscitation with terminally ill patients
Dean A Blackburn
bmj.com, 14 Sep 2003 [Full text]
Discussing Resuscitation
catherine s edwards
bmj.com, 14 Sep 2003 [Full text]
Limiting the exceptions to the "discuss with patients" rule
Peter J Allmark
bmj.com, 16 Sep 2003 [Full text]
AN AUDIT ON PATIENT INVOLVEMENT IN RESUSCITATION DECISON
RAJA BISWAS, et al.
bmj.com, 16 Sep 2003 [Full text]
Resuscitation and frail elderly patients
Shahid A Khan
bmj.com, 16 Sep 2003 [Full text]
Resuscitating the Terminally ill
Andrew D Lawson
bmj.com, 16 Sep 2003 [Full text]
Resuscitation - not all discussion leads to choice
Joanne Rule
bmj.com, 17 Sep 2003 [Full text]
DNR guidelines are unhelpful and counterproductive
Maurice L Slevin
bmj.com, 17 Sep 2003 [Full text]
No obligation to discuss resuscitation
Paul Diggory, et al.
bmj.com, 17 Sep 2003 [Full text]
Re: Resuscitating the Terminally ill
Kim Benstead
bmj.com, 17 Sep 2003 [Full text]
To discuss or not to discuss resuscitation in terminally ill patients
Rajeena Ackroyd
bmj.com, 18 Sep 2003 [Full text]
Why not discuss it BEFORE they're terminally ill?
James Austin
bmj.com, 19 Sep 2003 [Full text]
Should doctors discuss resuscitation with terminally ill patients?
Joseph K T Ngeh, et al.
bmj.com, 25 Sep 2003 [Full text]
Patient involvement is their right
Julie A Payne
bmj.com, 29 Sep 2003 [Full text]
Cardiopulmonary resuscitation isn't futile, it's irrelevant
john main
bmj.com, 1 Oct 2003 [Full text]
Resuscitation decisions should be made before referral to palliative care
Paul Diggory, et al.
bmj.com, 5 Oct 2003 [Full text]
Discussing Resuscitation
Sarah E Hampson, et al.
bmj.com, 7 Oct 2003 [Full text]
legal context and semantics of "discussion"
Ulrich S Schuler, ., et al.
bmj.com, 7 Oct 2003 [Full text]
Views of patients and oncology health professionals concerning discussion of do-not-resuscitate orders
Rhea Stein
bmj.com, 3 Dec 2003 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ