Doctors differ on whether hospices should follow cardiopulmonary resuscitation guidelines

Mar 29 2009

Experts in two papers published on bmj.com disagree on whether cardiopulmonary resuscitation (CPR) guidelines should apply to hospices.

Dr Max Watson and colleagues believe that CPR is not always appropriate for patients who are dying and that hospices should be able to develop their own guidelines. However, Drs Claud Regnard and Fiona Randall argue that it is "inconceivable" that hospices should seek exemption from the good practice set out in the UK guidelines.

Watson says that blanket rules on CPR do not work in hospices because the needs of these patients are unique. In a hospice "the goal for the majority is quality of life and a dignified death", he argues. Dr Watson goes further and says that full CPR facilities are often not possible in hospices and that it is disingenuous to discuss this issue with patients when only basic life support equipment and training may be available.

In conclusion, Watson calls for specific hospice guidelines that are clear, simple and robust and that one national policy for both the acute and the hospice sector is too ambitious.

But Regnard and Randall believe that the current guidelines "uphold essential core principles and values that particularly apply in end of life care." They argue that the guidelines provide essential protection for patients and that it makes no sense to seek exemption from them. For example, the guidelines protect patients from arbitrary discrimination, safeguard a patient's right to receive or refuse CPR, and protect dying patients.

Regnard and Randall also argue that CPR decisions are determined by what is in the patient's best interest. Therefore if a patient lacked capacity and was unable to survive CPR then the procedure would not go ahead, "these safeguards are essential to prevent unnecessary distress for patients, partners, and relatives at the end of life," they say.

"Working to different rules in hospices would result in confusion, exclude hospice patients from recognised good practice, and would seriously compromise working partnerships with colleagues in other settings. Exemption would create poorer, and thus inequitable, care for hospice patients," they conclude.