Published 26 March 2009, doi:10.1136/bmj.b986
Cite this as: BMJ 2009;338:b986

Head to Head

Should hospices be exempt from following national cardiopulmonary resuscitation guidelines? No

¹ St Oswald’s Hospice, Newcastle Hospitals NHS Trust, Newcastle upon Tyne NE3 1EE, ² Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, ³ Royal Bournemouth and Christchurch NHS Foundation Trust, Christchurch, Dorset

Cardiopulmonary resuscitation is traumatic and often unsuccessful in seriously ill patients. Max Watson and colleagues (doi:10.1136/bmj.b965) argue that current guidelines on its use are unsuitable for hospices, but Claud Regnard and Fiona Randall believe they ensure all patients get the best care

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

It is tempting to view hospices as unique therapeutic environments that demand special treatment. However, hospices have no desire to work outside national guidelines on good practice. The current cardiopulmonary resuscitation guidelines¹ uphold essential core principles and values that particularly apply in end of life care and are coherent with the Mental Capacity Act (England and Wales)^{2 3} and the Adults with Incapacity Act (Scotland),⁴ which govern decisions for patients who lack capacity. The guidelines reflect the good practice expected of hospices.

The guidelines provide essential protection against discrimination on irrelevant grounds. When a cardiorespiratory arrest is expected, and an advance decision is needed, the guidelines ensure this decision is tailored to the individual and to their circumstances, and not to arbitrary factors such as place of care.

When a cardiorespiratory arrest occurs unexpectedly, the guidelines state that there should be an initial presumption in favour of cardiopulmonary resuscitation unless the . . . [Full text of this article]

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