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This chapter discusses the development of cardiopulmonary resuscitation (CPR), the success rates of CPR, who should make the final decision about CPR, the CPR decision-making process involved in Advance Care Planning (ACP), and how to handle a conversation about CPR. The discussion shows that CPR is not as successful as many professionals think. CPR should not be offered if it is going to be futile. If patients have capacity they should be given the option to make decisions for themselves if there is a choice. CPR decisions may be complex and highly emotive. But by following the correct decision-making process, by not using false reassurance, and by being honest and direct, CPR decisions can be made appropriately. This can result in the patient having a dignified, and a good death.

This chapter discusses the different ethical issues that can be encountered when caring for the dying. It begins with the influence of the Liverpool Care Pathway for the Dying Patient (LCP) in ethical decision making, before examining an ethical framework and the best approach to ethical decision making. Issues with cardiopulmonary resuscitation, hydration, and euthanasia are also discussed. The chapter ends with a discussion on advanced directives, which should be recognized as a valid means by which patients can influence the treatments they receive when they are no longer competent to make decisions.

This chapter discusses the ethical issues connected to the care of the dying: issues of hydration and nutrition, issues of ventilation, and issues relating to capacity and decision making. It looks at an ethical framework that tackles the best approach to ethical decision making, which includes the four moral principles that govern the field of health care ethics, and discusses the influence and moral justification of the Liverpool Care Pathway for the Dying Patient (LCP) in ethical decision making. The chapter also discusses withholding and withdrawing interventions and treatments at the end of life and cardiopulmonary resuscitation (CPR).

This chapter addresses the ethics of providing cardiopulmonary resuscitation (CPR) to patients enrolled in hospice, given that patients who select hospice care have decided to forgo potentially life-prolonging treatment in exchange for comfort near the end of life. Influential arguments favoring offering CPR, such as the promotion of autonomy and justice, are reviewed. Relevant regulatory requirements in the United States and the United Kingdom, the evidence for futility of CPR in dying patients, and the symbolism of CPR are discussed. Finally, the chapter translates ethics into health policy by recommending that patients who enroll in hospice receive an out-of-hospital do-not-resuscitate (DNR) form along with other enrollment materials such as a medication kit and 24-hour contact telephone number. This approach respects the right of patients to make health care decisions, honors the choice they make about CPR, but recommends a DNR order as consistent with usual hospice practice.

People might make a variety of advance decisions that might apply to a range of issues about their health, welfare, finances, or other personal matters. This chapter concentrates on the advance refusal of treatment. It provides background to advance decisions and care planning for end of life, looking also at the context of English law, society, and culture. It looks at related topics such as Advance Decisions to Refuse Treatment (ADRT) and children, decisions relating to cardiopulmonary resuscitation, and assisted suicide. Lastly, it looks forward to raising public and professional awareness, education, and professional development. The discussion also notes that people in England and Wales now have a legal right to refuse even life sustaining treatment.

Discussions and decisions about whether or not cardiopulmonary resuscitation (CPR) should be attempted are challenging for patients and clinicians. Misunderstandings, poor decision making, and communication failures are common and have led to complaints, litigation, and adverse media reports. This chapter considers why decisions and recommendations about CPR and other potentially life-sustaining treatments are an important part of advance care planning (ACP), and are needed in other contexts as well. It summarizes what is needed to achieve high-quality, person-centred planning that is both ethical and lawful, and considers current efforts to develop a scheme that will encourage and support clinicians and their patients in that endeavour.