End of life care: Patients who have capacity

1. 137. If CPR may be successful in restarting a patient’s heart and breathing and restoring circulation, the benefits of prolonging life must be weighed against the potential burdens and risks. But this is not solely a clinical decision. You should offer the patient opportunities to discuss (with support if they need it) whether CPR should be attempted in the circumstances that may surround a future cardiac or respiratory arrest. You must approach this sensitively and should not force a discussion or information onto the patient if they do not want it. However, if they are prepared to talk about it, you must provide them with accurate information about the burdens and risks of CPR interventions,^xxx including the likely clinical and other outcomes if CPR is successful. This should include sensitive explanation of the extent to which other intensive treatments and procedures may not be seen as clinically appropriate after successful CPR. For example, in some cases, prolonged support for multi-organ failure in an intensive care unit may not be clinically appropriate even though the patient’s heart has been restarted.
2. 138. You should explain, in a sensitive manner, any doubts that you and the healthcare team may have about whether the burdens and risks of CPR would outweigh the benefits, including whether the level of recovery expected after successful CPR would be acceptable to the patient.
3. 139. Some patients may wish to receive CPR when there is only a small chance of success, in spite of the risk of distressing clinical and other outcomes. If it is your considered judgement that CPR would not be clinically appropriate for the patient, you should make sure that they have accurate information about the nature of possible CPR interventions^xxxi and, for example, the length of survival and level of recovery that they might realistically expect if they were successfully resuscitated. You should explore the reasons for their request and try to reach agreement; for example, limited CPR interventions could be agreed in some cases. When the benefits, burdens and risks are finely balanced, the patient’s request will usually be the deciding factor. If, after discussion, you still consider that CPR would not be clinically appropriate, you are not obliged to agree to attempt it in the circumstances envisaged. You should explain your reasons and any other options that may be available to the patient, including seeking a second opinion.