A doctor's experience of resuscitation decision making for older patients: coping with change

There has been a dramatic change in the way that resuscitation decisions are made for older hospital inpatients in the UK. In less than 20 years many geriatric medicine wards have moved from an "opt-in" policy (where the default position is not to provide resuscitation) to a position where resuscitation is widely available to older patients and clinicians are much more reluctant to make "do not attempt cardiopulmonary resuscitation" decisions on medical grounds alone. The drivers for this change are rooted in societal changes rather than scientific or legal advances. Older patients are increasingly educated and have higher expectations of health care, while doctors are more commonly criticised and have progressively less "power" in the doctor-patient relationship. Doctors in the UK are struggling with the growing volume and complexity of guidelines about resuscitation, which can prove very tricky to enact within current resources and priorities. Many are feeling stressed and under equipped to cope with the ethical and legal dilemmas of resuscitation decision making. The solution lies in better undergraduate and postgraduate training which enhances skills (such as consultation skills and ethical reasoning) and not just knowledge of laws, principles and guidelines.