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Decisions relating to cardiopulmonary resuscitation

October 2007

A joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing
Health professionals are aware that decisions about attempting cardiopulmonary resuscitation (CPR) raise very sensitive and potentially distressing issues for patients and people emotionally close to them. Some health professionals do not find it easy to discuss CPR with their patients, but this must not prevent discussion, either to inform patients of a decision or involve patients in the decision-making process, where appropriate. These guidelines identify the key ethical and legal issues that should inform all CPR decisions. These basic principles are the same for all patients, in all settings, but differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis. The guidelines provide a framework to support decisions relating to CPR and communicating them effectively.

These guidelines do not address all the complex clinical considerations that healthcare teams face. The guidelines do not distinguish between basic and advanced CPR because the underlying ethical and legal principles that govern decision-making are the same. The guidelines provide the general principles that allow local CPR policies to be tailored to local circumstances. Local policies may also contain more detailed guidance than can be provided here; this may include specific information about the allocation of individual responsibilities.

Professional nursing and medical organisations will be able to advise on the application of a CPR policy to specific areas of practice.

This document will be reviewed jointly by the British Medical Association, Resuscitation Council (UK) and Royal College of Nursing as policy and legislation develops. For example, the Mental Capacity Act 2005 (England and Wales) did not come into full force until the 1 October 2007 and the practical provisions for its implementation will only be clarified over time. The most up to date version of this guidance will be available on the organisations’ websites.

Download the statement in PDF format (334K)

Following misleading press coverage, some confusion has arisen about two statements in the document relating to the role of senior nurses in making decisions about cardiopulmonary resuscitation (CPR). The statements appear in sections 6 and 13 of the document. Erroneous reporting led to some concerns that doctors' opinions could be superseded, patients insufficiently consulted or that inexperienced nurses might make such decisions. Consideration of the statements in the context of the entire document makes clear these are misinterpretations. Healthcare is increasingly multi-disciplinary and the document is designed to be used in a variety of contexts, including where healthcare teams are led by nurses. It makes clear that responsibility for decision-making and CPR must always rest with the most senior clinician in charge of a patient’s care. In the majority of cases this will be a registered medical practitioner but in some situations, such as in nurse-led palliative care services, a senior nurse with appropriate training may fulfil this role, subject to local discussion and agreement. The document states that if there is genuine doubt or disagreement about whether CPR would be clinically appropriate a further senior clinical opinion should be sought. The guidance stresses that although the responsibility for decision-making rests with the most senior clinician, these decisions should not be made in isolation, but where appropriate, should involve the patient (or those close to the patient if s/he lacks capacity) and others involved in the clinical care of the patient. Teamwork and good communication are of paramount importance.

For information about developments following the publication of these guidelines, please contact any of the following:

Medical Ethics Department
British Medical Association
BMA House
Tavistock Square
London WC1H 9JP
Telephone: 020 7383 6286
Fax: 020 7383 6233
Email: ethics@bma.org.uk
Internet: www.bma.org.uk/ethics

Resuscitation Council (UK)
5th Floor
Tavistock House North
Tavistock Square
London WC1H 9HR
Telephone: 020 7388 4678
Fax: 020 7383 0773
Email: enquiries@resus.org.uk
Internet: www.resus.org.uk

Royal College of Nursing
20 Cavendish Square
London W1G 0RN
Telephone: 020 7409 3333
Fax: 020 7647 3431
Email : cardiovascular@rcn.org.uk
Internet: www.rcn.org.uk