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

BMJ 2009; 338 doi: (Published 27 March 2009) Cite this as: BMJ 2009;338:b986
  1. Claud Regnard, consultant in palliative care medicine12,
  2. Fiona Randall, consultant in palliative medicine3
  1. 1St Oswald’s Hospice, Newcastle Hospitals NHS Trust, Newcastle upon Tyne NE3 1EE
  2. 2Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne
  3. 3Royal Bournemouth and Christchurch NHS Foundation Trust, Christchurch, Dorset
  1. Correspondence to: C Regnard claudregnard{at}

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

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.

Protection against arbitrary discrimination

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 patient has a valid and applicable anticipatory decision refusing it. Therefore the new guidelines …

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