By Dr Mark Taubert
Clinical Director, Consultant Physician and Honorary Senior Lecturer in Palliative Medicine
Cardiopulmonary resuscitation (CPR) has many success stories, especially in younger patients with heart conditions. For those with multiple long-term conditions and palliative patients it is hardly ever successful and often not indicated at all.
Cardiopulmonary resuscitation can work in cardiac arrest situations, when, for instance, a nonsensical heart rhythm (that makes the heart ineffective) may be reversed by giving an electric shock. However, the cardiac rhythms involved in less acute ‘natural dying’ situations are not reversible, so cardiopulmonary resuscitation actually has no chance of success.
We should aim for people with serious life-limiting illnesses to have advance and future care planning documents, clearly outlining decisions on CPR before any deterioration. This paradoxically might mean talking to people about it when they are actually feeling rather well. But we need to find better ways to reach out more, and the only way is through patient empowerment. So resources like TalkCPR.com and the Second Conversation Project need to be shared widely.
Blanket guidance to administer CPR no matter what, whenever a do not attempt cardiopulmonary resuscitation or advance care planning form is not in place at the scene, is likely to mean that many people will be denied a peaceful death and will receive traumatic interventions, that are either not indicated at all, or very unlikely to lead to survival. The UK’s Nursing and Midwifery Council should urgently rethink their guidance to their nurses on this issue and give them the respect they deserve to make such calls.
The values we are currently using to dictate necessary measures when someone is close to death and dying, or actually dead, are biased towards defensive medicine practices. They are aggressive and often based on fallacious logic sequences. We can do better.
About Dr Mark Taubert
Mark is a palliative care doctor and senior lecturer. He created the TalkCPR.com website & app and has given a Ted Talk on why language and wording is important in palliative care. He writes for international newspapers and web based media outlets on contemporary medical topics. Mark took part in a BBC Horizon programme on Palliative Care alongside Kevin Fong, and has also done extensive media work with television, radio and online resources. He has talked about medical topics at the Edinburgh Fringe Festival and at Hay Literary Festival.
A few years ago he had a brief brush with fame, when his posthumous letter to David Bowie, which covers the components of good end of life care, went viral on the internet and in global newsrooms. The letter has been made into a classical music composition which was aired on BBC Radio 3, and has been publicly read out by various celebrities and drifters in locations including New York, London, Hay-on-Wye, Edinburgh and Berlin.
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