Do not resuscitate

Definition of resuscitation:

Resuscitation literally means: to restore someone to life. A definition that is used by the professionals involved is: ‘a treatment for the acute failure of the blood circulation and/or the respiration for which at least heart massage and/or ventilation forms a part and without which death would certainly occur’.

This would appear to be a treatment that should always be positively appreciated.

Yes or no

The dilemma as to whether or not to resuscitate arises because it is often difficult to indicate where the boundary lies, what the criterion is. Moreover, at that moment there is little time for extensive considerations, because if it is decided to resuscitate, every second counts. Also, ‘not resuscitating’ seems like ‘not providing care’, and that goes against the primary professional attitude of healthcare workers. So in the latter case, there will nearly always be a feeling of guilt.

As mentioned above, without existing agreements, it is impossible to indicate a clear boundary as to when resuscitation should not be done. A little clarity can be created if we summarise when resuscitation should be done.

Resuscitation is always a radical affair, which takes place on the boundary between life and death. There is a danger that too much is expected from human skill. For bystanders, it is often more acceptable if death takes place in a ‘natural’ manner, among the close relatives, than that after many heroic deeds (massaging and ventilating) and after a dashing ambulance drive to the hospital, it has to be concluded an hour later that the patient has died.

Consciously not resuscitating can also be radical. Not only does this go against the healthcare reflex, guilt can also occur immediately or at a later stage. A clearly recorded policy surrounding resuscitation per patient/resident provides clarity and will reduce unjustified feelings of guilt. Whether resuscitation is done or not, the situation will always have to be evaluated. Not only does this testify of professionalism, but also of psychosocial engagement.

In conclusion

Not resuscitating exclusively on the grounds of the quality of life motive carries the danger that one adopts a divine jurisdiction. On the other hand, the prevention of a feeling of guilt afterwards is not a professional motive for simply not starting to resuscitate.
With resuscitation, bystanders or the family often (understandably) hope for a miracle. However, real miracles usually take place in spite of, not thanks to, human intervention.