When I worked as an out-of-hours GP, I sometimes had to confirm death in patients who had received CPR. Speaking personally, I think that for some people, some of the time, attempting resuscitation is worse than futile.(1) It’s not good to see frail, elderly patients on the floor, with their clothing in disarray, and an intubation tube still protruding from their mouth.
After all, when anyone dies — whether it be from advanced cancer, organ failure or frailty — then her or his heart will inevitably stop as a final part of the dying process.
Family members are understandably distressed not only by what happens during the medicalised death that takes place during an unsuccessful resuscitation, but also afterwards, when it’s difficult to say goodbye to a medicalised corpse.
In contrast, when my own father died from metastatic cancer, no-one attempted CPR. Instead, I kissed him, told him I loved him and laid down beside him.
When I asked GPs what they really knew about CPR — I was shocked to find that they didn’t all know even the basic facts about how many people’s lives might be saved.(2)
I already knew that the public and patients have wildly ambitious views about CPR: significantly overestimating the chances of successful CPR in terminally ill cancer patients and frail elderly people (3).
TV fiction, after all, helps create an “illusion of efficacy”, in which “doctors are not powerless and … treatment does not stop once the heart stops beating”.(4)
But could I find out more about what people really think about CPR?
Compassion in Dying is a national charity working to inform and empower people to exercise their rights and choices around end-of-life care. They agreed to send some of their mailing list a questionnaire to ask their views about CPR.
Of course I wasn’t testing members of the public about survival rates like I had the GPs! Instead I asked questions of those who had been personally involved in DNACPR (Do Not Attempt CPR) decisions: Who was helpful? Who was unhelpful? I specifically asked about discussions WITHIN families — did everyone agree. I also asked:
If you could say one thing to the world about DNACPR decisions, what would it be?
More than 20 people replied. Unlike the GPs, almost nobody answered my questions.
They wanted to tell their personal stories. Some of these were horrifying, many were moving. All were deeply felt.
Only a very small minority did not actively want to share their stories more widely. ‘Debbie’ summed this up when she told me: “If anyone else can benefit or learn from my story, at least something positive will come out of it”.
So the next few posts will share some of the stories I was told. As requested, I have not given real names. But all the stories are real, and in real people’s real words.
1. Mawer, C. CPR can be futile – and is sometimes worse. BMJ 2014;348:g4180 http://www.bmj.com/content/348/bmj.g4180/rr/759532
2. Mawer, C, Limited GP knowledge of CPR survival rates. http://drcaromawer.com/limited-gp-knowledge-cpr-survival-rates/
3. Sundar S, Do J, O’Cathail M. Misconceptions about ‘do-not-resuscitate (DNR)’ orders in the era of social media. Resuscitation. 2015;86:e3. / Nava S, Santoro C, Grassi M, Hill N. The influence of the media on COPD patients’ knowledge regarding cardiopulmonary resuscitation. Int J Chron Obstruct Pulmon Dis. 2008;3(2):295-300; Adams DH, Snedden DP. How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders. J Am Osteopath Assoc. 2006 Jul;106(7):402-4.
4. Van den Bulck J, Damiaans D Cardiopulmonary resuscitation on Flemish television: challenges to the television effects hypothesis. Emerg Med J 2004;21:565-567 / Van den Bulck JJ. The impact of television fiction on public expectations of survival following inhospital cardiopulmonary resuscitation by medical professionals. Eur J Emerg Med. 2002 Dec;9(4):325-9