I’m responding to an issue on ‘twitter’ (but a word of caution, I really don’t follow twitter and rarely look at my account, so this is not an efficient way to get in touch with me; but it worked this time).

The ‘tweet’ says

“NZ case law confirms no requirement to resus when medically not in their best interest. #nzrc2014” same in Oz? Ping @EburnM

The link is to, I think, the New Zealand Resuscitation Council.

The case law is clear and that may be because the key cases come from the UK. I’m not sure what NZ case law the speaker was referring to; but in Australia the law that justifies treating a person who cannot give consent is the principle of necessity.  In In Re F [1990] 2 AC 1 Lord Justice Goff set out the test for necessity.  He said (p 25, emphasis added):

… not only (1) must there be a necessity to act when it is not practicable to communicate with the assisted person, but also (2) the action taken must be such as a reasonable person would in all the circumstances take, acting in the best interests of the assisted person.

In Airedale NHS Trust v Bland [1993] AC 789, the House of Lords had to consider whether doctors could withdraw treatment from Anthony Bland who had been crushed in the 1989 Hillsborough football stadium disaster.  Young Mr Bland was not dead, but was in a persistent vegetative state.  The judges agreed that there was no obligation to provide futile treatment and that the treatment that was keeping Mr Bland alive was indeed futile as there were no prospects for Mr Bland’s recovery.    As the treatment was not in Mr Bland’s best interests it could not be justified by the doctrine of necessity. Lord Browne-Wilkinson even suggested that if a practitioner

… comes to the reasonable conclusion … that further continuance of an intrusive life support system is not in the best interests of the patient, he can no longer lawfully continue that life support system: to do so would constitute the crime of battery and the tort of trespass to the person.

In that case they were talking about medical practitioners but there is no reason to think that the same test does not apply to paramedics and others where there action depends on ‘necessity’.

So a person who is called to resuscitate another need not do so if the treatment is not in the person’s best interests.  Most of the time a paramedic will not be able to make a judgement on that matter so of course resuscitation is the appropriate treatment, but that will not always be the case. For example a person may be terminally or chronically ill, perhaps expected to die or simply at the inevitable end of their life. It is legitimate to ask, for example, whether it is the best interests of a 99 year old person, wholly dependent on continuing care, to reuscitate them if they are found in cardiac arrest in their comfortable chair in front of the TV.   I don’t profess to be able to make those decisions, that is the ‘hard’ call for health practitioners, doctors, nurses and paramedics, but the law is clear, if treatment is not in the persons best interests it is not only appropriate to withhold that treatment, in Lord Browne-Wilkinson’s view it may be both a crime and tort to administer treatment that the practitioner has reasonable grounds to believe is not in the patient’s best interest.