DNACPR communication in ICU — FFICM MCQ

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EasyEthics and End-of-lifeDNACPR communication in ICUFFICM

An 86-year-old woman with severe frailty is admitted with pneumonia and multiorgan failure. The ICU consultant judges that CPR would not be clinically successful if she arrests. She has fluctuating delirium and her son is at the bedside asking about escalation. There is no valid advance decision. What is the most appropriate management?

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Correct answer: C — Explain the DNACPR decision sensitively and document the reasoning

A) Explain the DNACPR decision sensitively and document the reasoning is correct. Where the consultant judges CPR would not be clinically successful, the decision not to attempt it is a medical one made by the senior clinician, not something requiring family consent, but good practice still requires open, sensitive communication with those close to the patient and clear documentation of the reasoning. Fluctuating delirium means the patient lacks capacity now, so her son becomes the appropriate person to inform under a best-interests approach rather than someone whose agreement is needed. Current UK guidance requires clinicians to consult the patient or family unless this would cause harm, and confirms DNACPR forms are not consent forms. Why the other options are wrong: B, sign a DNACPR form as consent: the form records a clinical decision, not consent, and asking a relative to sign implies they are authorising or vetoing CPR, fuelling a well documented misconception. C, avoid discussing DNACPR to reduce distress: withholding discussion is only justified if disclosure would cause serious physical or psychological harm, not simply to avoid awkwardness, and blanket non-disclosure breaches candour and damages trust. D, offer CPR because the family requests it: CPR is not owed on request when judged clinically futile; families cannot demand an intervention that will not achieve its physiological aim, just as with any other inappropriate treatment. E, delay until delirium resolves: delirium may persist or she may arrest first, so deferring this safety-critical decision leaves her exposed to inappropriate resuscitation in the interim. Key point: DNACPR based on clinical futility is decided by the senior clinician and needs no family consent, but must be discussed sensitively with those close to the patient and fully documented.

Reference: Resuscitation Council UK, British Medical Association, Royal College of Nursing: Decisions relating to Cardiopulmonary Resuscitation (joint guidance, 2016, under review) and Resuscitation Council UK, CPR Decisions and DNACPR patient guidance, https://www.resus.org.uk/public-resource/cpr-decisions-and-dnacpr