There has been much discussion over the years about the resuscitation status of palliative care patients. These discussions are now often raised in an end-of-life context including in hospices.

Resuscitation should be part of broader discussions around advance care planning with patients and their families. These discussions should be held as early as possible, but on reality often occur later in an illness, and sometimes only raised when death is expected. When someone is an inpatient, these discussions (and decisions made) should be clearly documented in the case notes, but this is not always apparent or clear.

This situation will sometimes result in nurses not knowing what should happen in certain situations and whether to undertake resuscitation attempts or not. This can be especially difficult for example, when someone is imminently dying and their family are advocating for resuscitation (whether documentation is in place or not). Communication with families around decision making needs to take place early, so that these issues can be raised and perhaps avoid conflict later.

Resources

• NSW Health has produced Guidelines for end-of-life care and decision-making
• The Respecting Patient Choices Program has information relevant to Advance Care Planning, with State specific resources
• Help the Hospices (UK) has a Current Learning In Palliative Care online tutorial on Issues around Resuscitation
• The Christie NHS Trust (Oncology) in the UK has Cardiopulmonary resuscitation policy information for patients and carers
• The National Council for Hospice and Specialist Palliative Care Services and the Association for Palliative Medicine (UK) has a document: ETHICAL DECISION MAKING IN PALLIATIVE CARE - Cardiopulmonary resuscitation for people who are terminally ill (J R Coll Physicians Edinb. 2002;32(4):280.)
• Worcestershire NHS Services (UK) has produced a Children and Young Person’s Palliative Care Resuscitation Policy (2011)
• The General Medical Council in the UK has produced a guidance for doctors that may be of interest: Treatment and Care Towards the End of Life – Good practice in decision-making.
• The Southern Cross Bioethics Institute website provides access to information on bioethical legislation in Australia, much of which is relevant to palliative care. It can be different in each State and Territory, such as the Consent to Medical Treatment and Palliative Care Act 1995 (SA) and the Medical Treatment Act 1994 (ACT).
• Palliative Care Australia has presentations from the ‘Together 2009’ Conference, including Ethics and law

Related CareSearch pages

Nurses Hub
Communication
Advance Care Planning
Working with Families

GP pages
Communication

For Patients and Families
Communication

PubMed Topic Search
Resuscitation orders

Free Full Text Article

Wiese CH, Bartels UE, Zausig YA, Pfirstinger J, Graf BM, Hanekop GC. Prehospital emergency treatment of palliative care patients with cardiac arrest: a retrolective investigation. Support Care Cancer. 2010 Oct;18(10):1287-92. Epub 2009 Oct 8.

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Lats updated 09 May 2012*