Analysis

When and how to discuss “do not resuscitate” decisions with patients

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2640 (Published 20 May 2015) Cite this as: BMJ 2015;350:h2640
  1. Zac Etheridge, specialist registrar in geriatric medicine1,
  2. Emma Gatland, barrister2
  1. 1Medicine for Older People, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK
  2. 2Harcourt Chambers, London, UK
  1. Correspondence to: Z Etheridge zac.etheridge{at}yahoo.co.uk
  • Accepted 30 March 2015

A legal case last year resulted in changes to the law on patient involvement in resuscitation decisions. Zac Etheridge and Emma Gatland set out the implications for doctors and hospitals

Decisions about cardiopulmonary resuscitation are an often difficult yet vital part of medical practice. Such decisions aim to prevent undignified interventions at the end of life and ensure that the patient’s last hours or days are spent as peacefully as possible. In October 2014, the Resuscitation Council (UK), the British Medical Association (BMA), and the Royal College of Nursing (RCN) reviewed their guidance for doctors making decisions about do not attempt cardiopulmonary resuscitation (DNACPR) orders.1 The revised guidance follows a Court of Appeal decision in June 2014 in the case of Tracey v Cambridge University Hospitals NHS Foundation Trust and another. The decision significantly changes pre-existing practice on how and when DNACPR orders should be discussed with patients and others, and may have further legal implications.2

The case

The Tracey case was a claim for judicial review brought by the widower of Janet Tracey, who died in Addenbrooke’s Hospital in March 2011, aged 63. Tracey had terminal lung cancer diagnosed in February 2011 and was given a prognosis of nine months. She was offered chemotherapy and the chance to participate in clinical trials, which she accepted. About two weeks later, she was in a car crash and sustained a high cervical spine injury. She subsequently developed pneumonia, which together with her advanced lung cancer meant that she required ventilation in the intensive care unit. After two unsuccessful attempts to wean her from the ventilator, doctors placed a DNACPR notice in her notes without consulting or informing her. This was despite the fact that she had until that point expressed a strong desire to be involved in decisions about her care. …

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