Funding for research: Nil.
Clinical model for ethical cardiopulmonary resuscitation decision-making
Article first published online: 17 JAN 2013
© 2012 The Author; Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 1, pages 77–83, January 2013
How to Cite
Hayes, B. (2013), Clinical model for ethical cardiopulmonary resuscitation decision-making. Internal Medicine Journal, 43: 77–83. doi: 10.1111/j.1445-5994.2012.02841.x
Conflict of interest: Nil.
- Issue published online: 17 JAN 2013
- Article first published online: 17 JAN 2013
- Accepted manuscript online: 30 MAY 2012 07:04AM EST
- Manuscript Accepted: 22 MAY 2012
- Manuscript Received: 27 NOV 2011
Decisions to withhold cardiopulmonary resuscitation (CPR) for future cardiac arrest continue to be problematic, with a lack of consistency in how doctors approach this decision.
To develop a clinical model that can be used in education to improve consistency in CPR decision-making.
A qualitative study, using semistructured interviews with a total of 33 senior doctors, junior doctors and nurses from two Melbourne hospitals explored how decisions to withhold CPR are made. Interviews explored: issues arising; how doctors learn to make these decisions; how they deal with disagreement and their experiences of performing CPR. The transcripts were coded and analysed thematically.
Three major themes were identified: CPR as a life-and-death decision; good and bad dying; and trust. The research also defined the two elements to a CPR decision: (i) technical and (ii) ethical.
Applying ethical principles commonly used in medicine, a model for ethical CPR decision-making has been developed that identifies four patient groups, each with a different discussion aim. This approach simplifies the complexities of the CPR decision, providing a structured way to teach CPR decision-making to doctors and thereby achieve greater consistency in the decisions made.