Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Whilst there was clearly a breakdown in communication in this particular case between the patient, her family and her doctors which may in fact reflect an unwillingness by all involved to face the inevitable, I am concerned about such matters being decided by the courts rather than by the medical profession itself.
CPR is not a human right - it is a highly invasive medical treatment that has indications, contraindications, side effects and adverse reactions. It is no different from ECMO and indeed, you could argue that if you are being serious about CPR, then you should proceed to veno-arterial ECMO if you have been unable to establish the return of a spontaneous circulation within the hour! Let the Appeal Court consider that ....soon we shall have to discuss with our patients and their families and write in the notes why we feel ECMO and CPR are contraindicated!
Of course patients have a right to be informed about what treatments they are not going to receive - for example this lady was not going to receive a lung transplant, she was not a candidate for ECMO and she was not for CPR! The reason - because her physicians who knew about the outcome from such interventions believed that all of them would be ineffective!
It is illogical to focus on CPR and make such a big deal of it! However, it is uncaring not to explain to your patient why some commonly available treatments would be ineffective. But some patients just don't want to know!
Re: Appeal Court will decide whether a patient has right to be consulted before a “do not attempt resuscitation” note is put in notes
Whilst there was clearly a breakdown in communication in this particular case between the patient, her family and her doctors which may in fact reflect an unwillingness by all involved to face the inevitable, I am concerned about such matters being decided by the courts rather than by the medical profession itself.
CPR is not a human right - it is a highly invasive medical treatment that has indications, contraindications, side effects and adverse reactions. It is no different from ECMO and indeed, you could argue that if you are being serious about CPR, then you should proceed to veno-arterial ECMO if you have been unable to establish the return of a spontaneous circulation within the hour! Let the Appeal Court consider that ....soon we shall have to discuss with our patients and their families and write in the notes why we feel ECMO and CPR are contraindicated!
Of course patients have a right to be informed about what treatments they are not going to receive - for example this lady was not going to receive a lung transplant, she was not a candidate for ECMO and she was not for CPR! The reason - because her physicians who knew about the outcome from such interventions believed that all of them would be ineffective!
It is illogical to focus on CPR and make such a big deal of it! However, it is uncaring not to explain to your patient why some commonly available treatments would be ineffective. But some patients just don't want to know!
Competing interests: No competing interests