In the Midst of Life

the success of resuscitation from cardiopulmonary arrest. Furthermore, clinical policies should not be ageist in terms of specifying treatments that are not provided to people over a certain age, unless there is very good medical evidence to suggest a lack of benefit. In the medical literature about resuscitation, there is no evidence that the outcome is dependent on being under a certain chronological age, or that failure occurs over a certain age. The benefits of most medical treatments depend on the general condition of the patient, therefore discussions about the value or futility of resuscitation should be based on that rather than the patient’s chronological age.
    This is a reason why the most useful information when deciding whether to undertake or continue cardio-pulmonary resuscitation is the medical history. If, for example, a patient has presented with an exacerbation of breathlessness from chronic, extensive and end-stage respiratory failure, uses home oxygen and is house-bound as a consequence of their condition, then resuscitation from a cardiorespiratory arrest is less likely to be successful, and the prospect of a full recovery is unlikely. If such a patient is placed on a mechanical ventilator to take over their breathing and oxygenation, it could be very difficult to wean them off. If, on the other hand, a patient has been healthy and active until recently, and presents with respiratory failure due to extensive pneumonia, then resuscitation is more likely to be successful, and the chances of a full recovery are good. It is often the current or future quality of life that is the influential factor when assessments about resuscitation are being made by clinicians and families or carers on behalf of a patient.
    A successful resuscitation can be evident within minutes, but it may not be evident for perhaps thirty minutes or more that resuscitation has been unsuccessful; basic and advanced life-support measures can maintain the breathing and circulation for this length of time and longer. Decisions about when to stop resuscitation attempts are usually made by an experienced doctor when there has been no response, and there is no treatable or reversible causeof the initial collapse. As previously observed, resuscitation should be continued for longer than usual in specific circumstances, such as in the case of children or where the collapse has been caused by electrocution, drowning, hypothermia, poisoning, or anaphylactic shock.
    Advanced Decisions
    Advanced Decisions, advanced directives, or ‘living wills’ can be made to specify treatment that a person might or might not want in the future. There are three legal requirements for Advanced Decisions to be honoured – existence, validity and applicability – and these have been set out for England and Wales in the Mental Capacity Act (2005).
    For an Advanced Decision to be considered existent, it must be put down in writing, and be signed by the patient and a witness. For it to be valid, the Advanced Decision must not have been withdrawn or overridden by a subsequent Lasting Power of Attorney, and the patient must not have acted in a way that is clearly inconsistent with the Advanced Decision. To be applicable, the person must have had the mental capacity to make the decision about the proposed treatment at the time of writing. The Advanced Decision will not be applicable to treatments or circumstances that are not specified in the document. If there is any doubt or dispute about whether a particular advanced decision meets all the requirements, action may be taken to prevent the death or serious deterioration of the patient, whilst the dispute is referred to legal authorities. It is always very difficult to anticipate every possible scenario with regard to your health and healthcare, and therefore advanced decisions can be very limited in scope, especially when a patient presents with a new illness or condition.
    Should relatives witness resuscitation?
    Parents will almost always ask to be present when their child is being resuscitated. Historically, as with most medical procedures, relatives have been kept outside when cardio-pulmonary resuscitation is being performed. However, there are differing viewsbetween the public and healthcare professionals and the Resuscitation Council has published a useful document on their website about this issue. *
    From the relatives’ and partners’ point of view, being present may help them come to terms with