Intended for healthcare professionals

Observations Ethics Man

Cautionary tales about DNACPR

BMJ 2016; 352 doi: (Published 05 January 2016) Cite this as: BMJ 2016;352:i26

Futile resuscitation: Elephant in the room

The legal cases involving cardiopulmonary resuscitation (CPR) in terminally ill patients illustrate the need for better communication from health professionals.[1] But the elephant in the room is the unnecessary distress experienced by the families due to misconception about CPR as lifesaving critical medical intervention in terminally ill cancer patients.

The television and media portray CPR as a highly successful medical intervention. A survey in Nottingham, not surprisingly, showed that the general public are wildly optimistic about CPR in terminally ill cancer patients. 50% of surveyed subjects believed that CPR has at least 30% chance of successfully resuscitating a hypothetical 60-year-old cancer patient who is in hospice and has exhausted all chemotherapy options.[2] By contrast, the literature points to dismal outcomes following attempted resuscitation in such terminally ill cancer patients.[3]

There is an urgent need to educate public about futility of CPR in terminally ill cancer patients so as to avoid distress to families and most importantly avoid undignified death in patients.

1 Sokol DK. Cautionary tales about DNACPR. BMJ 2016;352:i26. doi:10.1136/bmj.i26

2 Sundar S, Do J, O’Cathail M. Misconceptions about ‘do-not-resuscitate (DNR)’ orders in the era of social media. Resuscitation 2015;86:e3. doi:10.1016/j.resuscitation.2014.10.014

3 Kjørstad OJ, Haugen DF. Cardiopulmonary resuscitation in palliative care cancer patients. Tidsskr Den Nor Lægeforen Tidsskr Prakt Med Ny Række 2013;133:417–21. doi:10.4045/tidsskr.12.0378

Competing interests: No competing interests

19 January 2016
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital NHS trust