Tuesday, 18 August 2015

When and how to discuss “do no resuscitate” decisions with patients. BMJ May 2015.

This article is particularly relevant to us following Dr Mark Priestley’s recent grand round presentation on end of life issues. Rulings from the Court of Appeal from “The Tracey case” last year in the UK has resulted in two important changes to the do no resuscitate guidelines:

  1. Patient distress is no longer sufficient justification for not discussing do not resuscitate decisions with patient. Doctors must discuss a DNR order unless they consider it is likely to cause the patient “physical or psychological harm”
  2. Futility is not a valid argument for not discussing a DNR order with a patient. The fact that a treating clinician considers that CPR will not work means that the patient cannot require him or her to provide it. The patient should though be entitled to know that the clinical decision has been taken and should be given the opportunity to seek a second opinion if desired.
The emphasis in the article is that if a not for resuscitation order is made, we should discuss this with the patient involved.

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