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My mum’s care means that decisions not to resuscitate must now be discussed with patients

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1084 (Published 02 March 2017) Cite this as: BMJ 2017;356:j1084

Conversation about Resuscitation

As an oncologist treating advanced cancer patients, I echo Kate Masters’s call for a “national conversation about death and dying to dispel myths and to inform the public about the reality of CPR”.[1] I agree honest communication and a reassurance to patients and family that DNR does not entail withholding of any beneficial treatment is critical.

Health care systems have placed defibrillators in public places with noble intent but this was not accompanied by widespread dissemination of information about benefits and limits of cardiopulmonary resuscitation. Little has been done to dispel the overwhelmingly positive myths that are being perpetuated by television shows and Hollywood movies.[2]

Not surprisingly, we found that adults significantly misjudge the success rates of resuscitation in various futile scenarios.[3] Unfortunately, these misconceptions were also present in the next generation of health service users, when we surveyed senior school students about their expectations of resuscitation success rates.

The human psyche is imbued with a “fight and survive against all odds” trait bestowed by our ancestors who survived harsh conditions. In addition to this trait, we should also nurture the concept of ‘good death’- having a peaceful exit rather a haphazard distressing exit- particularly in those human beings where death is expected and imminent.[4]

References
1 Masters K. My mum’s care means that decisions not to resuscitate must now be discussed with patients. BMJ 2017;356:j1084. doi:10.1136/bmj.j1084
2 Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary Resuscitation on Television — Miracles and Misinformation. N Engl J Med 1996;334:1578–82. doi:10.1056/NEJM199606133342406
3 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
4 Smith R. A good death. BMJ 2000;320:129–30. doi:10.1136/bmj.320.7228.129

Competing interests: No competing interests

14 March 2017
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospital NHS trust
City Hospital Campus, Nottingham