Problems with Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) discussions and decisions have long been recognised: conversations focussing on a treatment to be withheld are uncomfortable and are often avoided by clinicians and patients alike. They can be misunderstood to mean that other treatments should be withheld, and misunderstandings exist about their legal standing. ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) was designed to address some of these concerns. It nudges clinicians into more patient-centred conversations which focus on which outcomes are valued and feared before making recommendations about which treatments would be effective. Resuscitation is only ever discussed in the context of these overall treatment plans.
In the last few weeks, there have been several reports of ‘blanket’ DNACPRs, of patients being asked to ‘sign their own death warrants’ and a perception that groups of patients are being discriminated against by the use of DNACPRs.
I will discuss the historical problems with DNACPRs, the empirical ethics approach behind ReSPECT, the reasons for the ongoing misunderstandings ( amplified by the media), and the challenges of having good conversations about CPR in a climate of fear during the COVID pandemic.