Aged care staff should not be compelled to provide Cardiopulmonary resuscitation (CPR) on residents, according to a group of New Zealand academics.
University Otago researchers believe aged care facilities should be able to adopt “no chest compression” policies, so residents could have staff holding their hand and providing comfort in their final moments.
Dr Janine Winters, of the Dunedin School of Medicine’s Bioethics Centre, said the benefits of chest compressions for frail elderly people without a pulse were dubious and the burdens were high.
“Many people have a vision of chest compressions as care that miraculously brings people back to life, even people who are very sick … and they think it will also help people with end-stage disease and frailty,” Dr Winters said.
“CPR is performed as a default and forgoing it at the natural end of life is often seen as ‘giving up’, but, in reality, rest home staff are violently breaking people’s ribs as they die,” she said.
Dr Winters said in most circumstances, it was futile, as they died despite the procedure.
“As caregivers it’s hard on our souls to have to hurt people who should be dying a peaceful death,” she said.
Dr Winters said their research was inspired by a New Zealand rest home which created a ‘no chest compression’ policy.
She said after an audit, subsequent review, and no complaints, the facility was told it would be shut down if the policy was not retracted.
“Policymakers and regulators should allow aged residential care providers to implement such policies whereby, with pre-admission informed consent, no resident in the facility is offered chest compressions when pulseless.
“The conversation needs to occur before the crisis. It is difficult for some people and families to talk about their own mortality, but it is necessary to not have a default that hurts people,” Dr Winters said.
Read the full study: By Their Side, Not on Their Chest: Ethical Arguments to Allow Residential Aged Care Admission Policies to Forego Full Cardiac Resuscitation.
