Intended for healthcare professionals

Letters Cautionary tales about DNACPR

Futile CPR is tantamount to assault

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i602 (Published 10 February 2016) Cite this as: BMJ 2016;352:i602
  1. Richard Venn, consultant in intensive care
  1. Worthing Hospital, Worthing BN11 2DH, UK
  1. rvenn{at}doctors.org.uk

Regardless of the law,1 it is best medical practice to involve patients and relatives in all important medical decisions where “practicable and appropriate.”

However despite the High Court ruling in the case of Carl Winspear, I do not think it is best medical practice or “appropriate” to disturb relatives at 3 am to have a telephone conversation about DNACPR (“Do not attempt cardiopulmonary resuscitation”) if a frail patient, approaching the end of life, is not imminently dying. I would place a DNACPR notice in the medical notes and defer the conversation until the morning. If my patient was unlikely to survive until then I would phone the relatives at 3 am to discuss the priorities for ongoing treatment and symptom control, although ideally I would have this conversation face to face with the relatives in the hospital.

Completing the DNACPR notice at 3 am would avoid “unlawful CPR.”

CPR would be a breach of my patient’s rights under article 3 of the European Convention on Human Rights: no torture, inhuman or degrading treatment. Chest compressions to keep patients alive just long enough to experience the pain of ribs being broken and the trauma of a plastic tube being inserted into their windpipe, without anaesthetic, equates to torture.

I await the first successful prosecution of an NHS trust for “assault” after a futile CPR attempt.

Of course it would be preferable to stay well clear of the courts because as Charles Dickens highlighted “the law is a ass.” This is unlikely to happen however until the medical profession moves away from an obsession with “what we are not going to do” at the end of life, such as DNACPR notices and “not for escalation” decisions. We need to educate the public on the priorities for treatment and symptom control at the end of life. Ongoing dialogue around “emergency care and treatment plan” is a start in the right direction.

Footnotes

  • Competing interests: None declared.

References

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