Published 26 March 2009, doi:10.1136/bmj.b965
Cite this as: BMJ 2009;338:b965

Head to Head

Should hospices be exempt from following national cardiopulmonary resuscitation guidelines? Yes

¹ Northern Ireland Hospice, Belfast, BT15 3LH, ² University of Ulster, Coleraine, Ireland, ³ Northern Ireland Palliative Medicine Training Scheme, ⁴ Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice Section, University of Edinburgh.

Cardiopulmonary resuscitation is traumatic and often unsuccessful in seriously ill patients. Max Watson and colleagues argue that current guidelines on its use are unsuitable for hospices, but Claud Regnard and Fiona Randall (doi:10.1136/bmj.b986) believe they ensure all patients get the best care

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

The patient population in UK hospices is changing. Patients with malignant and non-malignant diseases, increasing disease complexity, and multiple comorbidities are attending from earlier in their illness for management of symptoms and supportive care. Indeed, almost half of hospice patients are now discharged.¹ Yet, despite these trends we must remember that hospice patients have illnesses that are not curable.²

Hospices should be exempt from applying blanket national cardiopulmonary resuscitation guidelines³ because the needs and treatment goals of hospice patients differ from those of patients in other care settings. Instead, the hospice movement should develop its own guidelines, which would take account of patients close to death as well those admitted for symptom control and rehabilitation.

The joint statement from the British Medical Association, the Resuscitation Council (UK), and the Royal College of Nursing on cardiopulmonary resuscitation¹ is a helpful step forward but translates disappointingly into the hospice sector. It is . . . [Full text of this article]

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Rapid Responses:

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Specialist palliative care support for good practice guidance is vital.

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bmj.com, 5 Apr 2009 [Full text]

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