ADVANCE DECISIONS ABOUT CPR TREATMENT
The appropriateness of CPR should always be considered on an individual patient basis. There is never a justification for blanket policies to be in place. An advance decision that CPR should not be attempted can be made if either of the following is relevant:
A patient makes a competent advance refusal
- Where CPR is not in accord with the recorded, sustained wishes of the patient who has capacity for that decision.
- Where CPR is not in accord with a valid applicable advance healthcare directive (living will). A patient's informed and competently made refusal which relates to the circumstances which have arisen should be respected.
The treatment of CPR would not be of overall benefit for the patient
- Where a patient's condition indicates that effective CPR would fail.
- Where the patient judges that the benefits of medically successful CPR are likely to be outweighed by the burdens of that treatment or of the sustainable life that is likely to be achieved.
Where CPR may realistically be successful it is important to assess whether the patient has the capacity to be involved in a decision about the overall benefit of such a treatment. If capacity is present, the issue should be broached with the patient in the context of end of life care choices. If appropriate the patient should be asked whether they have thought about the matter and would want to discuss it further. If the patient declines, then it is appropriate to make the decision without consulting the patient further. It would be appropriate to ask the patient who they would wish to be consulted.
If the patient does not have capacity, then the principles of the Adults with Incapacity (Scotland) Act 2000 apply. Intervention with CPR should be considered if it is likely to be of overall benefit for the patient. If the clinical opinion is that there would be no benefit, then a DNACPR decision is appropriate. The past and current views of the patient, if known, must be taken into account and there is a duty to consult relevant others and ask if there is any valid advance directive which should be assessed to see if it is applicable to the current situation. Proxy decision-makers, i.e. welfare attorney/welfare guardian/person appointed under an intervention order, must be involved in the process as they would have the same power to consent or refuse consent as a capable patient would.