Many people have come to view cardiopulmonary resuscitation (CPR) as a routine intervention following cardiac arrest, and they insist on CPR for their loved ones even when the physician explains its likely futility. Physicians who refuse a family member’s request to perform unwarranted CPR risk becoming the center of media, legal, and disciplinary scrutiny. Although CPR is largely perceived as a benign life-saving intervention, it inflicts indignity and possibly pain on a dying patient and should not be used when it is unlikely to succeed or to benefit the patient if successful. The growing acceptance of do-not-resuscitate orders for patients with advanced cancer has not spread to families of patients suffering from the late stages of other degenerative or terminal illnesses. Having blunt discussions about the true consequences and risks of CPR might foster greater willingness to abstain from administering CPR to patients unlikely to benefit.

This article was originally published by HMP Communications LLC (Annals of Long-Term Care: Clinical Care and Aging), 05/16/2011.

Dylan Harris, MBBCh(Hons), MRCP, DipPallMed, Specialist Registrar in Palliative Medicine, Princess of Wales Hospital, Bridgend, UK.

Dementia is a progressive incurable illness. In the advanced stages of the disease, decisions need to be made whether to withhold or withdraw life-sustaining treatment. This article reviews the principles of deciding a patient’s best interests when he or she lacks mental capacity, the role of advance statements, and principles for the practising physician to consider in common withholding/withdrawing treatment scenarios that arise in clinical practice, such as artificial feeding, cardiopulmonary resuscitation, and antibiotics for pneumonia.
Key words: dementia, palliative care, withholding and withdrawing treatment, artificial feeding, resuscitation, antibiotics.