Key Objectives of Decision-Making About CPRUnderstand when CPR should or should not be attempted – CPR is an emergency procedure, but it is not always appropriate or effective.Recognise ethical and le…
Understand when CPR should or should not be attempted – CPR is an emergency procedure, but it is not always appropriate or effective.
Recognise ethical and legal principles – Decisions must be based on beneficence, non-maleficence, justice, and autonomy.
Improve communication – Effective discussions ensure patient preferences are respected.
Know when to stop CPR – Continuing futile resuscitation may cause harm and distress.
Record and document decisions clearly – Ensures continuity of care and compliance with legal frameworks.
Decision-making in CPR is guided by four core medical ethics principles:
Autonomy – Patients have the right to make their own decisions. A mentally competent individual can refuse CPR, even if it is life-saving.
Beneficence – Healthcare providers must act in the best interests of the patient. If CPR is unlikely to provide meaningful survival, it may not be appropriate.
Non-Maleficence – CPR should not be performed if it will cause unnecessary suffering without benefit.
Justice – CPR decisions should be fair and non-discriminatory, ensuring access to care based on need rather than age, disability, or other factors.
✔ Shared Decision-Making – Healthcare professionals should engage in discussions early, rather than in an emergency.
✔ Explore the patient’s values – Discussions should focus on goals of care, not just CPR as an isolated decision.
✔ Advance Care Planning (ACP) – CPR decisions should be part of broader treatment plans, including ICU care, ventilation, and hospital admission.
✔ Respect patient preferences – Patients should not feel pressured but must be given the opportunity to make informed decisions.
✔ When not to discuss CPR – If discussing CPR is likely to cause significant distress, it may be avoided, but this decision must be documented.
Tip: Some patients may change their decisions over time, so ongoing discussions are essential.
What if there is disagreement? – If there is a dispute between the healthcare team and the family, a second opinion should be sought. In rare cases, legal action may be required.
✔ When CPR will not restart the heart and breathing – If CPR has no realistic chance of restoring life, it should not be attempted.
✔ If a valid DNACPR or ADRT exists – These must be respected unless the circumstances of arrest differ.
✔ When CPR will cause significant harm – If CPR would result in severe neurological damage, pain, or prolonged suffering, it may be inappropriate.
CPR should be stopped if:
The patient achieves Return of Spontaneous Circulation (ROSC).
The patient has a valid DNACPR order.
The resuscitation effort is clearly futile (e.g., asystole for >20 minutes without reversible cause).
Continuing CPR would cause more harm than benefit.
Special Considerations: In cases like hypothermia, drug overdose, or electrocution, CPR should be continued for longer before making a decision to stop.
✔ Clearly record DNACPR, ADRT, or CPR recommendations in patient records.
✔ Ensure paper and electronic records are accessible to all healthcare providers.
✔ Use standardised documentation systems, such as the ReSPECT form, to ensure clarity across healthcare settings.
✔ CPR should not be attempted if it is futile or causes more harm than benefit.
✔ Early discussions and shared decision-making improve patient-centred care.
✔ DNACPR and ADRT orders must be documented and respected.
✔ Legal frameworks (Mental Capacity Act, ADRT, IMCA) guide decision-making for incapacitated patients.
✔ Communication is key – Healthcare teams must ensure that patients and families understand their options.
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