Intended for healthcare professionals


What investigations and procedures do patients in hospices want

BMJ 1998; 316 doi: (Published 11 April 1998) Cite this as: BMJ 1998;316:1166

Providing ineffective treatment is futile

  1. Rosemary Morgan, Consultant physician in geriatric medicine,
  2. Debra King, Consultant physician in geriatric medicine
  1. Department of Medicine for the Elderly, Wirral Hospital, Upton, Wirral, Merseyside L49 5PE
  2. Department of Medicine and Elderly Care, Royal Hampshire County Hospital, Winchester SO22 5DG
  3. Radcliffe Infirmary, Oxford OX2 6HE
  4. Aintree Palliative Care Team, Fazakerley Hospital, Liverpool L9 7AL
  5. Department of Psychology, University of Exeter, Washington Singer Laboratories, Exeter EX4 4QG
  6. Macmillan Team, Hounlow and Spelthorne Community and Mental Health NHS Trust, West Middlesex Hospital, Isleworth, Middlesex TW7 6AF.
  7. Mary Ann Evans Hospice, George Eliot Hospital, Nuneaton CV10 7DJ
  8. St Michael's Hospital, Warwick, CV34 5QW
  9. Department of Surgical and Anaesthetic Sciences, University of Sheffield, Royal Hallamshire Hospital, S10 2JF

    EDITOR—In their short report Meystre et al say that “legal advice suggests that if patients request resuscitation it should be provided,”1 referring to our study on the views of elderly patients on cardiopulmonary resuscitation.2 We contacted the Medical Protection Society and the Medical Defence Union by telephone during our study because a patient in the study who had metastatic lung cancer “demanded” cardiopulmonary resuscitation if he had a cardiac arrest. We were advised that cardiopulmonary resuscitation should be provided if a patient requested it since failure to do so could result in litigation. Subsequently, the Medical Protection Society and the Medical Defence Union said that the advice they had given was specific to the case cited and could not be generalised, and that they would not agree with the assertion “legally if a patient requests cardiopulmonary resuscitation it should be provided.”3 We agree with this as providing treatment that is ineffective is futile.

    Cardiopulmonary resuscitation is a useful treatment for some patients. “Do not resuscitate” orders should be made in accordance with the resuscitation policies that all hospitals should have in place.4 It may be necessary to include patients in the discussion but it is not appropriate to do so if cardiopulmonary resuscitation is deemed medically futile, unless the patient initiates the discussion.5 If a patient requests cardiopulmonary resuscitation when it is inappropriate, discussion must show compassion and reasoning, which requires good communication skills. Doctors must remember that they are under no legal obligation to provide cardiopulmonary resuscitation if patients or relatives demand it. They do, however, have to provide an explanation for their medical decision.

    Undergraduate and postgraduate education programmes often omit to teach when and how to discuss cardiopulmonary resuscitation with patients. We have introduced regular tutorials to our preregistration house officers so …

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