“Do Not Attempt Resuscitation” Draft Guidelines, Google AI, and Trends to Watch in 2020

In December 2019, the Indian Council of Medical Research (ICMR) has released a draft document to guide physicians on decisions not to provide cardiopulmonary resuscitation (CPR) to patients. The draft document narrates that the death is inevitable in certain situations at the terminal stage of certain diseases and providing CPR may only increase the suffering of such patients. The draft document recommends that physicians should provide complete information to patients or their family members about circumstances under which CPR would in the best judgment of physicians be considered medically inappropriate. It emphasizes the need to explain such circumstances to patients and family members, so they understand the implications of CPR in the context of the incurability of the disease and the nearly impossible opportunity for any meaningful survival.

The draft document issued by ICMR provides information such as an algorithm, with a flowchart guiding the physicians on how best to proceed, and in which circumstances CPR should be provided. It will guide treating physicians to take the decision whether or not to perform the CPR on the background of incurable disease where the patient’s chances of survival are extremely low. The flowchart provided by ICMR is provided in [Figure 1].{Figure 1}

Figure 1: Algorithm for do not attempt resuscitation decision making (from draft document issued by the Indian Council of Medical Research)

ICMR has invited feedback and comments on the Draft ICMR Position Paper on “Do Not Attempt Resuscitation (DNAR)” from relevant stakeholders. It is requested that comments/feedback pertaining to the same may be conveyed in the prescribed format by E-mail to Dr. Roli Mathur ([e-mail]).

The guidelines on such topics are very sensitive topic, as there will always be those who oppose the decision. Leaving an individual to pass away will cause distress and unhappiness for family and friends. However, the draft document does highlight the importance of providing detailed yet simply understood reasoning to the family of the affected individual through every step of the decision-making process.

Until now, there has been no formal classification or guidelines provided by any government body to establish an appropriate course of action in such a circumstance. This places physicians in a difficult situation in which neglecting to perform CPR can have terrible repercussions both to their career and, indeed, to their safety.

The question which will also be debated is priority when the patient requires CPR (especially in patients who are brought to emergency department); whether the physician shall spend time in explaining patient’s relatives about DNAR rather than actually providing CPR to the patient. The time spent at that time by the physician on DNAR may be looked differently leading arguments.

Considering the sheer volume of violence committed against physicians, many are in a situation where they may feel threatened in opting not to perform CPR. Although following guidelines on the practice will, of course, not alleviate the threat of violence in its entirety, it can, at the very least, help inform the family as to decisions made in terms of giving CPR.

It will be crucial to know interest taken by physicians in reporting comments on the draft document to ICMR and contents of finalized document once released by ICMR post addressing comments.

Publication History

Received: 09 February 2020

Accepted: 12 March 2020

Article published online:
23 May 2021