Clinical model for ethical cardiopulmonary resuscitation decision-making.
BACKGROUND
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.


OBJECTIVE
To develop a clinical model that can be used in education to improve consistency in CPR decision-making.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Advance Care Planning Program, Northern Health and School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia. barbara.hayes@nh.org.au
B
B
Hayes
D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation / Q000941:ethics*; D003661:Decision Support Techniques; D006323:Heart Arrest / Q000628:therapy; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D018447:Medical Futility; D008505:Medical Staff, Hospital / Q000523:psychology; D017008:Negotiating; D009726:Nurses / Q000523:psychology; D057240:Patient Preference; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011368:Professional-Family Relations; D036301:Qualitative Research; D016414:Resuscitation Orders / Q000941:ethics*; D035502:Trust; D014739:Victoria