Healthcare professionals are aware that decisions about whether or not CPR will be attempted raise sensitive and potentially distressing issues for patients and those emotionally close to them. As a consequence, there has been stand-alone professional guidance on CPR decision-making
since the 1990s and guidance jointly published by the British Medical Association (BMA), Resuscitation Council (UK) and Royal College of Nursing since 2001 (sometimes referred to as the ‘Joint Statement’).
The high-level ethical principles that were embedded in the 2007 edition of the Joint Statement underpin the guidance in the third edition. This revision of the guidance places even greater emphasis on ensuring high-quality communication and recording of CPR decisions. This is in response to public and professional debate about CPR decisions, and to feedback from individual healthcare professionals and professional
bodies. The BMA, the Resuscitation Council (UK) and the Royal College of Nursing hope that these changes will help to support all healthcare professionals in their day-to-day consideration of decisions about CPR.
The guidance identifies the key ethical and legal principles that should inform all CPR decisions. The high-level ethical principles are the same for all people, in all settings, but differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis. How these individual decisions are made is also guided by the law, which differs between adults and children and differs in England and Wales, in Scotland and in Northern Ireland. For example, a central tenet of the mental capacity legislation in England and Wales is ‘best interests’ and in Scotland it is ‘benefit’. These terms can be interpreted in largely the same way and so, for the purposes of this guidance, are used interchangeably in parts of the
This guidance provides a framework to support decisions relating to CPR and effective communication of those decisions. It also highlights relevant legal
requirements and differences.
This guidance does not address all the complex clinical considerations that healthcare teams can face. It provides general principles that allow local CPR policies to be tailored to local circumstances. Local and regional policies may also
contain more detailed guidance than can be provided here; they may include, for example, specific information about the allocation of individual responsibilities.