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----Original Message Follows---- From: Andrew Conway Morris <[log in to unmask]> >... these patients should be allowed to die with dignity and without the >benefit of the CCU nurse/JHO/medical student bouncing up and down on their >chest. That said, without this practice would the one or two patients who >have been sucessfully resuscitated have survived? --> Regardless of my belief that, if there is no significant chance for a positive outcome, then resuscitation should stop, I am troubled by the frequent assumption that there is any loss of "dignity" in having a team of dedicated professionals trying to resuscitate you. Indeed, we have all heard, as on this list, of the very occasional case who survives despite having no real chance of doing so. And even then this does not prove we should go on if we honestly are very confident that there is no significant chance of success. But if one does go on resuscitating and this is later assessed as having been an attempt which should have been abandoned, then so be it. The relevant team and its leader can be shown the relevant protocol applicable to their institution, where it says they should have stopped and they will improve their performance. Of course, most are taught on ALS and other such courses. Both in these courses as well as in many other places, I have failed to find protocols which clearly state when to stop. Even the advice from learned members of this list, which I find extremely logical and similar to my thinking, is yet to be reflected officially. I would hesitate to be too critical with anyone who continues an honest effort until better protocols exist. I often perform CPR - I would rather not call it "bouncing" which, in my opinion, diminishes the dignity of the professional!. I do perhaps also occasionally go beyond the point of most efficient treatment (in hindsight), but not because I wish to practice - I sometime need an extra cycle or 2 to make sure of the time to review all I have/not done and allow for input from my team. Many of these concepts are developing right now! Evidence is being gathered as to the futility of certain tpes of resuscitation circumstances. But we should not be "angry" with those who stick with their current practices until the evidence is translated into newer ones _________________________________________________________________ Stay in touch with absent friends - get MSN Messenger http://www.msn.co.uk/messenger