Resuscitation decisions are often not documented early enough

Editor—I was not surprised to see that national guidelines on resuscitation decisions are being ignored.¹ I have worked in several hospitals on acute medical wards and often have seen fudged resuscitation decisions. I believe that the decision on resuscitation should, as with any treatment, be made by the patient first. If the patient is unable or too ill to make the decision it should be made in consultation with the nearest relatives available. The doctor's decision should be based on information from these two sources. In the rush of an acute admission there may not be time to gather this information, so an advance directive would be useful here.

Ideally all the information about a patient would be seen by the admitting consultant quickly and a resuscitation decision made quickly. Often, however, patients are admitted in the night or not seen until later on by the consultant. In these circumstances the medical senior house officer or registrar on call will have to make a decision about resuscitation, either (and preferably) before or during a crash call. One of the key decisions to be made is the point at which to stop curative medicine and move to a palliative approach towards a dying patient. I suspect that this decision is frequently made but often not documented. Nurses in particular find this lack of clarity stressful. I also found this a stressful part of medicine.

I believe that an edict that all staff must resuscitate patients unless the consultant says otherwise is a recipe for futile, unwarranted, and unkind cardiac arrest calls for patients who are dying. These patients should be allowed to die in peace without lots of young doctors performing heroic but pointless cardiac resuscitation.

The medical wards of hospitals admit the oldest and sickest people in our community. I am certainly in favour of treating as many people as possible, but there comes a time for letting people go gently. I hope that if I am in that state my doctors (whatever grade they are) will have the courage to let me die peacefully, without useless resuscitation attempts.