Head To Head

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

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b965 (Published 27 March 2009) Cite this as: BMJ 2009;338:b965
  1. Max Watson, consultant in palliative medicine1, lecturer in palliative medicine21,
  2. Alan McPherson, specialist trainee in palliative medicine3,
  3. Scott A Murray, St Columba’s hospice professor of primary palliative care4
  1. 1Northern Ireland Hospice, Belfast, BT15 3LH
  2. 2University of Ulster, Coleraine, Ireland
  3. 3Northern Ireland Palliative Medicine Training Scheme
  4. 4Primary Palliative Care Research Group, Division of Community Health Sciences: General Practice Section, University of Edinburgh.
  1. Correspondence to: M Watson max.watson{at}nihospicec.org

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 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 …

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