DNACPR should be discussed if a CPA is likely or if the patient might refuse CPR however unlikely an arrest
I must admit to being unable to read the article (not a subscriber - not wealthy enough) but if we take CPR as being treatment for a 'stopped heart' (in other words, there is effectively no blood circulating, and an inevitable loss of consciousness within seconds, followed within a matter of minutes by death - 'in CPA'), the situation seems to be legally clear. At least in England.
If CPR could potentially re-start the heart, then section 4(5) of the MCA means it should be attempted, unless the patient had forbidden CPR (which, of course, must have been done before the CPA occurred), or unless an MCA 'best-interests decision' is against resuscitation. Section 4 decision making is too complex to describe briefly. So sticking to patients who are mentally capable until a CPA occurs, the logic is that the clinicians should seek the patient's decision about potentially-successful CPR before a predictable CPA, and they should also seek the patient's decision if it seems possible that the patient would forbid CPR irrespective of why a CPA occurred, and irrespective of how unlikely a CPA is (this is 'I refuse CPR however it occurs - I would already prefer to be dead' at its simplest, or the more subtle 'I would prefer the certainty of non-resuscitation and death, to the uncertainties inherent in both 'successful' CPR and 'the rest of my life'). Clinicians should avoid making 'quality of life' decisions, and should confine themselves to providing clinical prognoses.
I have read the Tracey ruling - it was complicated, and 'rather muddled in terms of certainty about what had happened'. But one possible interpretation, as I read the ruling, is that Mrs Tracey was willing to discuss CPR but only if her family were present during the discussions, and as the relationship between the clinicians and the family had broken down, the clinicians did not want to hold discussions with the family present.
Rapid Response:
DNACPR should be discussed if a CPA is likely or if the patient might refuse CPR however unlikely an arrest
I must admit to being unable to read the article (not a subscriber - not wealthy enough) but if we take CPR as being treatment for a 'stopped heart' (in other words, there is effectively no blood circulating, and an inevitable loss of consciousness within seconds, followed within a matter of minutes by death - 'in CPA'), the situation seems to be legally clear. At least in England.
If CPR could potentially re-start the heart, then section 4(5) of the MCA means it should be attempted, unless the patient had forbidden CPR (which, of course, must have been done before the CPA occurred), or unless an MCA 'best-interests decision' is against resuscitation. Section 4 decision making is too complex to describe briefly. So sticking to patients who are mentally capable until a CPA occurs, the logic is that the clinicians should seek the patient's decision about potentially-successful CPR before a predictable CPA, and they should also seek the patient's decision if it seems possible that the patient would forbid CPR irrespective of why a CPA occurred, and irrespective of how unlikely a CPA is (this is 'I refuse CPR however it occurs - I would already prefer to be dead' at its simplest, or the more subtle 'I would prefer the certainty of non-resuscitation and death, to the uncertainties inherent in both 'successful' CPR and 'the rest of my life'). Clinicians should avoid making 'quality of life' decisions, and should confine themselves to providing clinical prognoses.
I have read the Tracey ruling - it was complicated, and 'rather muddled in terms of certainty about what had happened'. But one possible interpretation, as I read the ruling, is that Mrs Tracey was willing to discuss CPR but only if her family were present during the discussions, and as the relationship between the clinicians and the family had broken down, the clinicians did not want to hold discussions with the family present.
Competing interests: No competing interests