BMJ  2003;327:615-616 (13 September), doi:10.1136/bmj.327.7415.615

Education and debate

For and against

Doctors should not discuss resuscitation with terminally ill patients

AGAINST

¹ Department of Palliative Care and Policy, King's College London, Weston Education Centre, London SE5 9RJ irene.higginson@ kcl.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 with chronic illness and cancer have special needs. Their treatment options are complex, are offered over longer periods of time because of improved survival, and have benefits and risks that are difficult to weigh. Terminally ill patients often have to make decisions about their final treatment after a protracted period of illness, investigation, and treatment. But this does not mean they don't want to be involved. Poor communication and information leads to poor patient satisfaction, symptom management, and compliance.^1-3 New guidance on effective models of supportive and palliative cancer care suggests that effective training in communication can improve patient satisfaction and some outcomes.⁴

Discussion about cardiopulmonary resuscitation is as important as discussion about any other treatment in terminally ill patients. Some doctors may avoid talking about do not resuscitate orders because they feel it is important to offer a positive outlook. However, silence or incorrect information has been shown . . . [Full text of this article]

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

Relevant Articles

"Right to die": Legal view of right to life and death could threaten philosophy of palliative care

John C Chambers
BMJ 2005 330: 1388. [Extract] [Full Text] [PDF]

Doctors should not discuss resuscitation with terminally ill patients: FOR

Charlotte Manisty and Jonathan Waxman
BMJ 2003 327: 614-615. [Extract] [Full Text] [PDF]

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]  
• 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]  
• 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]  
• Chambers, J. C (2005). "Right to die": Legal view of right to life and death could threaten philosophy of palliative care. BMJ 330: 1388-1388 [Full text]  
• (2003). Hit Parade. BMJ 327: 1234-1234 [Full text]  

Rapid Responses:

Read all Rapid Responses

A 'blanket approach' to resuscitation might be harmful.

Rónán Collins
bmj.com, 13 Sep 2003 [Full text]

Bravo

Elizabeth J Brierley
bmj.com, 24 Sep 2003 [Full text]

What do patients want at this stage of their lives?

Andrew Thorns
bmj.com, 25 Sep 2003 [Full text]

CPR - the mother of all interventions

W. Matthew Widdowson, et al.
bmj.com, 6 Oct 2003 [Full text]

A hairy chest protects against unwanted resuscitation.

Phillip J. Colquitt
bmj.com, 7 Oct 2003 [Full text]

Do patients want to discuss resuscitation?

Madhumita Bhattacharyya, et al.
bmj.com, 8 Oct 2003 [Full text]

Online poll

Find out more >>