Observations Life and Death

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BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d5251 (Published 17 August 2011) Cite this as: BMJ 2011;343:d5251
  1. Iona Heath, president, Royal College of General Practitioners
  1. iona.heath22{at}yahoo.co.uk

Why is patients’ consent presumed for cardiopulmonary resuscitation, asks Iona Heath, writing in a personal capacity

Many general practitioners will have shared my experience of witnessing the possibility of a peaceful and dignified death being sabotaged by an ill considered and ill fated attempt at resuscitation. Patients who have collapsed in extreme old age or who are slipping away from life with disseminated cancer continue to be subjected to futile procedures for the sake of a perverse kind of political correctness, despite a sustained critique going back at least a decade.

The American Heart Association describes the noble goals of “emergency cardiovascular care” as being “to preserve life, restore health, relieve suffering, limit disability, and reverse clinical death.”1 Who could argue with these sentiments? The problem is that, if these are the goals, cardiopulmonary resuscitation (CPR) has a tendency to fall somewhat short. The data indicate that survival to discharge after cardiac arrest in hospital is infrequent.2 In 14 720 resuscitation attempts on adults in 207 US hospitals between 2000 and 2002, 44% of the patients survived for 20 minutes after CPR …

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