Paternalism not to blame for failure to implement resuscitation policies

Barriers to implementing a policy not to attempt resuscitation in acute medical admissions: Prospective, cross sectional study of a successive cohort; BMJ online first

Many seriously ill patients admitted to hospital cannot discuss resuscitation in line with current guidelines, finds a study published online by the BMJ today.

The results suggest that paternalism is not driving the failure of implementing effective hospital resuscitation policies.

Current guidelines on resuscitation advocate explicit discussion of resuscitation with all competent patients within 24 hours of admission. However, it has been shown that this is not happening, and the presumption has been that this is due to time constraints and doctors' reluctance to cause patients anxiety.

To investigate what prevents patients from being questioned about their views, researchers identified 374 seriously ill patients admitted to the emergency department of a London hospital.

Only 74 (20%) patients agreed to discuss resuscitation and accept an information sheet about it. Of the remaining patients, 80% could not discuss resuscitation within 24 hours of admission. (half could not be approached for practical reasons and almost one-third refused to discuss this aspect of their care).

Of the 74 patients who read the leaflet, 88% reported having little or no prior knowledge about resuscitation, 95% understood it, and 78% preferred that resuscitation decisions were discussed with them. Fifty-five patients (74%) did not mind discussing resuscitation and these patients showed an overall decline in anxiety after this discussion.

"It is unfair to assume that paternalism is driving the failure of implementing a policy not to attempt resuscitation," say the authors. "We must ask our patients if they wish to be involved, and until they feel well enough, health professionals continue to carry the responsibility for decisions on resuscitations."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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