Raising the Dead? The limits of CPR

Raising the Dead? The limits of CPR

George Skowronski¹, Ian Kerridge², Edwina Light², Gemma McErlean³, Cameron Stewart⁴, Anne Preisz⁵, Linda Sheahan², St George Hospital Sydney², Sydney NSW³, NSW Australia^Sydney, Australia 5^NSW,

¹St George Hospital, Sydney, NSW, Australia
²Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
³University of Wollongong, Wollongong, NSW, Australia
⁴Law School, University of Sydney, Sydney, NSW, Australia
⁵Sydney Childrens Hospital Network, Sydney, NSW, Australia

Abstract

An 84-year-old man was admitted to hospital with painful, disseminated small cell lung cancer and was managed by the palliative care team, but a formal inpatient resuscitation plan was not documented. On the twelfth day of his admission, he was found unresponsive, cold, cyanosed and stiff. In the absence of a written order to the contrary, nurses commenced CPR and called a ‘code blue’ response. Further resuscitation attempts were abandoned after about twenty minutes. The Clinical Ethics service was consulted by a distressed nurse.

In discussion, senior nurses readily agreed that CPR was not in the patient’s interest, and was completely futile. Nevertheless, they defended their actions because of perceived legal liability and fear of disciplinary action should they fail to initiate CPR in the absence of a written order. They argued that nurses could not be responsible for the determination of death, and discontinuation of CPR could only be authorised by a doctor.

We argue that failure to initiate CPR in an obviously dead person does not contravene any legal or regulatory requirement, and that CPR in these circumstances is associated with harms, including disrespect for the dead individual as well as potential psychological distress among family members and attending staff. Prioritising documentation over thoughtful decision-making is a form of defensive medicine, and an unintended consequence of the managerialist, risk-averse culture of the modern hospital. Clinical ethics support can provide a safe space for guided reflection to understand and improve such practices.

Biography

George Skowronski is a retired intensive care physician, who has been the Clinical Ethics lead at St George Hospital, Sydney since 2019. He has particular interests in organ donation and transplantation ethics, and, more broadly, in critical care ethics.