I have a suggestion for how family-carers and 999 paramedics 'could be reconciled' for CPR decision-making - feedback from family-carers welcomed.

mike stone 26/02/19 Dignity Champions forum

The PDF contains some analysis, and also a suggestion about how decision-making should proceed if paramedics and family-carers are interacting, with an emphasis on known 'end-of-life' situations. I have asked for comments from 999 paramedics on Twitter, in a series of tweets which start at:

https://twitter.com/MikeStone2_EoL/status/1100331130316877827

If I get any replies on Twitter, I will 'move then over' to this thread.

If any 999 paramedics, or any family-carers are reading this (as it is family-carers and 999 paramedics WHO ARE PRESENT, it is the views of those two categories of people I am most interested in) would care to post opinions here, please do so.

In essence [the PDF contains 'the argument'] I am proposing that the 'rules for' whether or not cardiopulmonary resuscitation should be attempted by 999 paramedics, are these:

Now, unfortunately, even if we trust everyone, and accept that all family-carers are acting 100% honestly, it doesn't follow that all family carers will agree about what the patient would have wanted to happen: often, the family-carers will all agree, but 'honest disagreements' are possible even within 'well-informed family-carers' and must be accepted. What I cannot accept, is the idea that a 999 paramedic can understand what is in the patient's best interests, better than the patient's close family and close friends.

How might this be joined together, applying my 'first do not insult' principle, but also respecting the situation of the 999 paramedics and the law's 'preservation of life' fall-back position? This is what I would suggest - I started to describe this sometime around 2014.

THESE ARE 'THE RULES' I am suggesting:

The paramedic, after describing the clinical situation, treatment options and prognoses, asks all of the carers present 'are you sure of what the patient would want us to do?' - so, for CPR that simplifies to 'do you know if he would want us to attempt CPR?'.

Then, the paramedic believes the answers [by default] assuming the carers are reasonably 'calm and composed', and:

If all of the carers say 'I know she wouldn't want CPR' then the paramedics DO NOT attempt CPR;

If some of the carers say 'I don't know' but one or more firmly say 'I know she wouldn't want CPR' then the paramedics do NOT attempt CPR (this one is perhaps contentious - it requires debating: see the footnote);

If all of the carers say 'I don't know' then the paramedics DO attempt CPR;

However many carers say 'I'm sure he wouldn't want CPR', if even one carer says 'I'm sure he would want CPR' then the paramedics DO attempt CPR.

Footnote: the premise, is that any family-carer who promptly and 'forcefully' says 'I'm sure my dad wouldn't want CPR' will have a good reason to say that – but not reasons which could be elaborated during an arrest beyond 'because he's made it clear to me!' - so, presented with such 'certainty' from one or more relatives, any other relatives who are only willing to say 'erm … I'm not sure' are not refuting the assertion strongly enough.

The first of those respects the family-carers 'by not insulting them' - and the final one respects the 'fall-back of preservation of life when things are uncertain' principle.


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James Foad 26/02/19

Good point mike, but surely that is why we have D.N.R. Form. to give the person at at end of life a choice. and to protect the family and family-carers. How does anyone really know if a person wants to be revived or not.. It is surely that persons decision. Another way around it might be When you are perhaps diagnosed with Cancer or something incurable the perhaps that would then be the time to discuss end of life care after a few days or a couple of weeks to give that person a chance to get their head around their situation and their fears and emotions out the way, before discussing End of life and CPR or DNRs. obviously this would depend on how near the end of life is as to when this discussion takes place.

In the case of no D.N.R. perhaps the person and their family could discuss this with a solicitor and have something in writing as to which family member makes the final call.

mike stone 16/03/19

A paramedic replied to something I had posted on Twitter, with a 'really interesting' phrase - this is the PDF I've quickly cobbled-together, in response to that phrase.

Associated files and links: