Cardiac arrest and natural dying

Dan Beckett_talking about natural dying on BBC Radio Scotland. Cradle to Grave

Natural dying and cardiac arrests are quite different things. Dr Dan Beckett has explained how cardiac arrests may (may!) have a reversible cause, while natural dying doesn’t.

In a cardiac arrest, the heart stops first. Quite often this follows a heart attack and problems with electricity in the heart. Defibrillation may sometimes be able to restart the heart.

In a natural death, the heart tends to stop last, as part of the natural process of dying. CPR is likely to be futile because the body is dying. It may even be harmful since it leads to an undignified death, and may prolong the dying process.

Here’s Dr Beckett talking. The audio recording is only 1 minute and 38 seconds. Scroll down if you want to read everything he said about natural dying.

I know, from personal experience how correct Dr Beckett is. When my dad died of cancer (that had spread and spread), I was with him when he took his last breath. When I put my hand on his chest, his heart was still beating. This felt really disturbing. I was tired and upset (and hadn’t eaten for a few days while I was sitting with him). I remember wondering — for a few seconds — if I was hallucinating.

But I wasn’t hallucinating at all: I was just witnessing a natural death. The sort of gentle natural death with your family sitting with you that many people might choose, when they have to die.

Dr Gordon Caldwell has made very similar, but more detailed, points about the limits of CPR, in a situation of ‘ordinary dying’. I don’t think that the death of anyone can ever be called ‘ordinary’. After all, everyone is someone’s daughter or son, mum or brother. But Dr Caldwell is 100% right that:

  • In natural dying the heart stops last: after the vital organs have stopped functioning. Even if, by a miracle, the heart could be restarted, it would soon stop once again. Debbie described this in her moving story about her mum – elsewhere on my website.
  • Even within the context of a cardiac arrest, the body requires a lot of resilience to bounce back from CPR. Most older people in fragile health do not have the resilience to withstand CPR.
  • Doctors should make a Correct Diagnosis, and follow this by the Correct Treatment. It’s not appropriate to try CPR for the wrong diagnosis. In natural dying, the diagnosis is not sudden cardiac arrest; but progressive deterioration (slow or swift) towards the natural end of life. CPR is not the Correct Treatment in these circumstances.
  • Instead, the correct treatment is being with the dying person “listening, talking, touching, alleviating physical, emotional and spiritual distress, comforting the relatives and tender respectful cleaning and laying out of the body after death.”

Here’s all of what Dr Beckett said, in case the BBC don’t keep the Radio Scotland recording up on their website:

“CPR or CardioPulmonary Resuscitation is treatment that we can give to someone who is in cardiac arrest. It’s a combination of chest compressions and, sometimes, helping a patient to breathe.

The purpose of the chest compressions is not to restart the heart but simply to maintain blood flow to the brain before definitive treatment. This is usually the heart being shocked with something called a defibrillator. 

When we’re thinking about CPR and cardiac arrest, it’s useful to think about what a cardiac arrest is. A cardiac arrest happens when the heart stops first. Quite often it’s reversible and quite often it’s the result of a heart attack and problems with electricity in the heart. Applying a defibrillator to restart the heart – well, the sooner that happens, the higher chance there is of success.

There’s a crucial difference between a cardiac arrest which may have a reversible cause and natural dying, when the heart stops because the body itself is dying.

In a natural death, the heart tends to stop last as part of the dying process. Attempting CPR or resuscitation is futile because the body is dying. That’s when we would not consider doing CPR. Not only is it likely to be futile, but it’s also likely to be harmful. It may prolong the dying process and also leads to an undignified death.”

And here’s more detail from Dr Caldwell:

You can read his ‘personal reality’ of CPR here.

And his letter to the General Medical Council about how CPR is unethical when people are naturally dying is here 

Lastly, here’s a 53 minute video of Dr Caldwell talking to an audience of medical staff about CPR and people who are frail.

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