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I see once again do not attempt resuscitation orders have made the news again. Itâs striking how badly understood DNACPR orders are. https://www.dailymail.co.uk/news/article-8995229/Elderly-patients-given-Not-Resuscitate-orders-against-families-wishes.html
Resuscitation is like any other medical treatment, it comes with risks and benefits, it imposes considerable burdens on those it is attempted in. Successfully restarting someoneâs heart is only the first bit, and most cases it then requires a period of intensive care.
During resuscitation attempts it is frequent that bones will be broken, and even if the heart restarts there is significant risk of brain damage- brain damage so severe the patient may remain permanently comatose
The risks of these bad outcomes are greater the older and frailer the patient is. When there is little or no chance of good outcome then it is wrong and unethical to subject a patient to invasive and aggressive treatments with significant harms.
What is a âgood outcomeâ may to some extent be an individual decision, but I think most people would agree that being left barely aware, completely dependent on others for all care and breathing through a tracheostomy or dying on a ventilator is not a âgood outcomeâ
Most people, if asked how they would like to die, would request that their passing is peaceful, pain-free and dignified. Having been involved in hundreds of resuscitation attempts I would say that is the polar opposite of most peoplesâ idea of a âgood deathâ
When there is a realistic prospect of a good recovery, and the patient is willing to accept the risks, then offering resuscitation is the right thing to do. But where such realistic prospects of a good recovery do not exist then it is wrong to offer futile treatments.
Imagine a doctor who offered risky chemotherapy for a tumour they knew couldnât be cured, or radical surgery for a condition that it wouldnât work for- that would be clearly unethical, indeed it would border on assault. Resuscitation is no different.
Most people donât want to think about dying, but itâs far better to do this when one still has ones facilities, when one is not in the midst of an emergency, at 3am.
Itâs also vital to understand that DNACPR is specific to not attempting an invasive and potentially harmful procedure- it does not mean âdo not treatâ it does not mean âdo not careâ. It many situations it means âallow a natural and dignified death when the time comesâ.
I donât know what happened in the conversation reported here. But I do know that we would all benefit from thinking more about our wishes should we be unable to express them. Thinking about what matters to us when we near the ends of our lives.
And we need a much better public understanding of what cardiopulmonary resuscitation actually entails, what it means, itâs risks and benefits and chances of success. The media and the medical profession have a major role in ensuring this understanding occurs.
