Hints and Tips for the Exam

This is a challenging station, but if you keep it simple, you will get most of the marks. It is highly unlikely that you will face this task alone in your early postgraduate years, as the decision-making and discussion with patient and family should be handled by the most senior doctor available on the team, and this is almost always the consultant.

When to Discuss Resuscitation Status with Patients

If cardiorespiratory arrest is not expected to occur, it is not necessary to have this discussion with the patient unless they wish to do so.

If a decision is taken on clinical grounds that the patient is inappropriate for resuscitation, discussion with the patient is not always required. In some circumstances, it may cause more distress than benefit, for example with end-stage terminal disease in which death is imminently expected. Such decisions should be made on an individual basis.

Some patients will not want to have this discussion, while others may request a second opinion. In either case, the patient’s choices must be respected.

Patients who lack capacity may have made a living will, or have appointed an attorney, deputy or guardian in order to make their wishes known. The family may also know what the patient is likely to have wanted. While the patient’s wishes should be respected, they can only refuse resuscitation. They cannot demand treatment that, on clinical grounds, is deemed inappropriate (i.e. if they are made ‘not for resuscitation’ for sound clinical reasons, they cannot demand to be resuscitated).

When Is Resuscitation Inappropriate?

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