- Ethical issues in end of life decisions trial#
- Ethical issues in end of life decisions professional#
Mental Capacity Act 2005 sections 24-26.Where attempted CPR has a reasonable chance of successfully re-starting the heart and breathing for a sustained period, and patients have decided that the quality of life that can reasonably be expected is acceptable to them, their wish for CPR should be respected. If this is not possible, the joint BMA, RCN, and UKRC guidance advises that the patient’s wishes should be respected but that, in the event of a cardiac arrest occurring, the decision about precise measures to be taken should be made by the clinician.ĭoctors cannot be required to give treatment contrary to their clinical judgement, but should be willing to consider and discuss patients ’wishes to receive treatment, even if it offers only a very small chance of success or benefit. Should the possible effects on medical and nursing staff of attempting CPR on a patient with virtually no chance of success be considered? It maybe that with fuller discussion between John and his clinicians a consensus view will be achieved. In considering his best interests, have the clinical team taken into account his personal perspective? Perhaps his daughter is getting married next week and he wants any chance, however small, to be able to see her married. In considering John’s autonomy it is necessary to know if he has understood what CPR entails and the likelihood of success or failure. For John, even a small chance of success may be seen as far from futile if he has the chance of another week of life. If the clinicians think that CPR would be futile this raises questions about what is meant by futile treatment and how different people would regard the predicted level of success or failure in this case. However further exploration of the clinicians’ reasons for not wishing to attempt CPR and John’s reasons for his choice is required. Should John be given CPR in the event that he suffers a cardiac arrest?Īt first glance this case seems to be a conflict between John’s autonomous choice and the objective view of the clinicians regarding his best interests. After discussion with his consultant John says he wants everything done for him, including CPR. This is because it is highly unlikely to be successful and it would inflict damage because of John’s fragile ribs (he has secondary deposits of cancer in his ribs) and because he will die very shortly from his cancer. The consensus of opinion from the medical team is that, if John has a cardiac arrest while on the ward, attempts at resuscitation would not be appropriate. As a result of his advanced disease, it is likely that vital organs such as his kidneys and heart will fail.
In discussion with the medical team John expresses a belief that he may respond to treatment although his consultant has told him that no further chemotherapy is possible and that he has only a few weeks left to live.
Ethical issues in end of life decisions trial#
He is now nearing the end of a trial of a new chemotherapy regime with no sign of remission of his cancer. John is a 55 year old man with lung cancer which initially responded to chemotherapy but has now relapsed.
Ethical issues in end of life decisions professional#
The importance of discussing the decision with the patient and/or their relatives is highlighted in the professional guidance. It would not be in the patient’s best interests to prolong treatment where it is futile to do so. It is important to consider not only whether CPR will provide a benefit to the patient, but also the potential harm that may be caused by CPR. The guidelines issued by the BMA RCN and UK Resuscitation Council sets out a framework for developing a policy for DNAR orders. These issues are discussed below using a short hypothetical case to illustrate some of the points to be considered.Ī “do not attempt resuscitation”, or “DNAR” order is an advance decision that Cardiopulmonary resuscitation (CPR) will not be attempted. Decisions to withhold or withdraw treatment.Do not attempt resuscitation(DNAR) orders.Ethical Issues - End of life decisions Issues that might present to a CEC
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