End of life care: Patients who lack capacity

1. 140. If a patient lacks capacity to make a decision about future CPR, you should consult any legal proxy who has authority to make the decision for the patient. If there is no legal proxy with relevant authority, you must discuss the issue with those close to the patient and with the healthcare team. In your consultations or discussions, you must follow the decision-making model in paragraph 16. In particular, you should be clear about the role that others are being asked to take in the decision-making process. If they do not have legal authority to make the decision, you should be clear that their role is to advise you and the healthcare team about the patient. You must not give them the impression that it is their responsibility to decide whether CPR will be of overall benefit to the patient. You should provide any legal proxy and those close to the patient, with the same information about the nature of CPR and the burdens and risks for the patient as explained in paragraphs 137-138.
2. 141. If the legal proxy requests that CPR with a small chance of success is attempted in future, in spite of the burdens and risks, or they are sure that this is what the patient wanted, and it is your considered judgement that CPR would not be clinically appropriate and not of overall benefit for the patient, you should explore the reasons for the proxy’s request. If after further discussion you still consider that attempting CPR would not be of overall benefit for the patient, you are not obliged to offer to attempt CPR in the circumstances envisaged. You should explain your reasons and any other options that may be available to the legal proxy, including their right to seek a second opinion.