Peter Lerman is the staff respiratory therapist at Wilton Meadows Health Care Center in Wilton, Connecticut. Recently his article CPR and Informed Consent was published in the February 2020 issue of Provider Magazine. Wilton Meadows is fortunate to have Peter inhouse five days a week. We will share a bit of the article here on our blog.
Peter is registered with the National Board for Respiratory Care and licensed in the states of New York and Connecticut. Peter is also a Red Cross certified CPR Instructor for Health Care Workers. Peter has experience working in critical care, trauma, long term acute and sub-acute care, rehabilitation, and with long term skilled nursing patients. He has worked at Danbury Hospital in Connecticut and Saint Barnabus Hospital in the Bronx. Also, under his scope of practice as a Respiratory Therapist, Peter worked in the Sleep Lab at Putnam Hospital performing sleep studies (PSG) and CPAP/BiPAP titration. Peter is a Certified Smoking Cessation Counsellor and a Certified COPD Educator.
The article outlines that informed consent is one of the pillars of modern medical care. The most foundational principal is patient autonomy which cannot stand without the support of informed consent. The one medical intervention which does not require consent which intervention is undertaken with ‘presumed consent,’ is cardiopulmonary resuscitation (CPR).
Attempting to Resuscitate
First, consider that the choice offered is somewhat deceptive when presented as ‘Do Not Resuscitate’ (DNR) vs ‘Full Code;’ an option implying that staff can and will resuscitate a patient but they must make a declaration in writing instructing us not to if that is their preference. It is most likely that the staff will not be able to resuscitate. In light of this, the American Heart Association in 2005 changed its preferred terminology from ‘Do Not Resuscitate’ to ‘Do Not Attempt Resuscitation’; DNR became DNAR. All that staff can offer to do is Attempt Resuscitation.
Injuries in the Elderly
There is also the consideration of the injuries commonly sustained by patients who are receiving CPR. In the article Peter quotes David Davis, MD, of Christian Hospital in St. Louis “It is violent. If you don’t do it hard enough, you can’t move any blood.” But if you do thrust hard enough, “you’re going to break the ribs and maybe the sternum.” (NY Times, 8/10/12)
Bringing CPR Into Reality
Ellen Casey, Administrator of the Wilton Meadows Health Care Center, a skilled nursing facility in Connecticut, is happy to be on board with an initiative to have new admissions and current residents become better educated on the ‘real world’ possibilities and results of CPR for older patients.
“Everyone has the right to be fully informed before they make any health care decision,” she says. “This includes end-of-life decisions. We are grateful to have the opportunity to provide excellent care for people at a very special time in their lives. Advanced care planning allows everyone on the health care team to provide that care in the best possible way,” says Casey.
Providers can easily do a better job of assisting patients’ choice and helping them to get the end of life care they want for themselves. Should patients learn the probability of surviving CPR and still want it provided, there is no question that it should be. Providers should still rely on both the foundation of patient autonomy and the pillar of informed consent. All providers are encouraged to work little bit harder on the ‘informed’ part.
Listen to Peter speak on Informed Consent on Sound Cloud:
Read the full article here: