Nurses' power over life and death 'will spare heartache'

Share this article

NEW guidelines giving experienced nurses the power to decide over the resuscitation of patients will spare families the "heartache" of futile revival attempts, it was claimed last night.

The Royal College of Nursing (RCN) said its members were often in the best position to decide if someone should receive cardiopulmonary resuscitation (CPR) or be left to die in dignity.

Britain-wide guidance published on Friday extended the power of judgment in such matters to "suitably experienced" nurses. Until then, consultants and GPs were the only medical staff who could make the decision.

The new rules, agreed by the British Medical Association (BMA), the RCN and the Resuscitation Council, are aimed at preventing the "unnecessary" resuscitation of patients who would not benefit.

In contrast to its television portrayal, the reality of CPR is that survival rates can be as low as 5% for certain individuals. It can also be "a prolonged and traumatic procedure", the Resuscitation Council said.

The new guidelines state that each patient should be individually assessed and a plan of treatment communicated to all healthcare professionals who come into contact with them.

Dr Peter Carter, general secretary of the RCN, said: "Often it is the nurse who has the closest bond with the patient and their family and is in the best position to decide if CPR is in their interest.

"This guidance - which has the backing of doctors and the Resuscitation Council - should help spare patients and their families the heartache and indignity of repeated and sometimes futile resuscitation attempts."

The Patients Association has also backed the guidance.

A spokesman said: "Nurses will know more about the personality of the patient and their attitude towards death during a severe illness.

"Nurses should always be part of the team making the decision on whether or not a patient should be resuscitated."

But some clinicians insist that nurses lack the training and experience to make that judgment.

Dr Peter Saunders, general secretary of the Christian Medical Fellowship, which has more than 4,500 members, said: "Nurses should not be making such a decision. It is always going to be a difficult call to decide whether someone should live or die.

"The decision should always be taken after very careful consideration by senior doctors.

"There is absolutely no way this can be delegated to nursing staff. It's unfair on them to make such a call - they have neither the training nor the experience."

But Dr David Pitcher, honorary secretary of the Resuscitation Council, said: "The updated guidance states clearly that it is not always appropriate to distress a person who is dying, perhaps in the last few days of life, by discussing attempted resuscitation when clearly CPR would not be successful.

"The survival rate may be as low as 5% in certain individuals. The outcomes are extremely variable, but they are nothing like what we see on TV. Sometimes it is a prolonged and traumatic procedure and is not always successful."

Dr Vivienne Nathanson, the BMA's head of science and ethics, said an electronic health register could make the distribution of resuscitation information easier.

She said: "One of the great advantages is that everyone will know about the patient's condition but if someone is scooped off the street we might not have that information and a clinical judgment would still have to be made."

"This is about a decision that should take place when a cardiac arrest is likely to happen but the key is still, if in doubt, if you haven't had a chance to get any knowledge, you must resuscitate."