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Nurses will be able to decide that a dying patient should not be resuscitated under controversial new guidelines. Until now, only GPs and consultants could say whether there was any point in continuing efforts to save a life.

But guidance issued last night by the British Medical Association will allow ‘suitably experienced nurses’ to make this crucial decision. The rules, published by the BMA in conjunction with the Royal College of Nursing and the Resuscitation Council, aim to help medical staff decide whether to resuscitate patients if their heart or breathing stops. It says medical staff should use their judgment over whether there is any point in using the most common resuscitation method – chest compression, or ‘cardiopulmonary resuscitation’.

But for the first time, this includes ‘suitably experienced nurses’.

Patients’ groups criticised the move, calling it ‘another nail in the coffin’ of safety for the elderly and vulnerable which would condemn many to an ‘early death sentence’.

In the past, nurses faced with such a situation would have carried on until a GP or a consultant made the decision to give up hope.

The new guidelines, which cover hospitals, hospices and ambulances, were introduced because some experts feel that sustained rescuscitation efforts can be undignified and often worthless.
The RCN said only consultant nurses or senior nurses who have a supervisory role would be able to make these decisions.

General secretary Dr Peter Carter said: ‘This joint guidance recognises the important part that nurses play in decisions related to resuscitation. Dr Vivienne Nathanson of the BMA added: ‘In TV medical dramas, CPR is often the wonder intervention that saves patients’ lives and reunites them with their loved ones. ‘Unfortunately, in real life the survival rate after a patient has a cardiac arrest and receives CPR is relatively low.’

Nurses will only be able to make such decisions if their local hospital trust agrees they can.
The Department of Health leaves it up to professional bodies such as the BMA issue guidance and individual trusts decide how to implement them.

SOS-NHS Patients in Danger, a group formed by relatives who believe a loved one died because of deliberate starvation, dehydration or with-holding of medication, have criticised the guidelines.

Spokesman Julia Quenzler said: ‘By giving a senior nurse this power, is it yet another means of distancing doctors from their patients’ deaths?’

Katherine Murphy, chief executive of the Patients’ Association, called for greater clarity over which nurses should be allowed to make life-or-death decisions. ‘We would hope that these senior nurses will be properly qualified and in a position to make these decisions,’ she added.

[Comment: It’s becoming painfully obvious that the big nursing organizations-both in the US and abroad- will not forcefully uphold ethical standards that protect both the nurses and the general public. Here in the US, we have the National Assn. of Prolife Nurses ( I would encourage all nurses to join organizations like this. By the way, several years ago, there was a case of several Austrian nurses accused of euthanasia. The authorities said that, at first, the nurses killed the patients that they felt sorry for but later killed the patients that caused the most trouble. A cautionary tale, indeed. N. ValKo RN]

[27October2007, Daniel Martin; N Valko RN, 28Oct07;]