By Their Side, Not on Their Chest: Ethical Arguments to Allow Residential Aged Care Admission Policies to Forego Full Cardiac Resuscitation.

Abstract

We argue that Aged Residential Care (ARC) facilities should be allowed to create and adopt an informed "No Chest Compression" (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard choking care, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person's end-of-life experience and increasing ARC residents' understanding of the burdens of ineffective treatments for pulselessness.