This question has been shared from another, South Australian, Facebook group so I hope the person who posted it doesn’t mind that it is reproduced, and answered here.  The question is:

Does anyone know if as registered nurses, we can decide against providing CPR in the community, both as bystanders or as part of the GoodSAM app as a responder, if the patient has clear signs of death that would not be responsive to CPR such as rigor mortis.

I would like to understand our responsibilities as I worry we can’t legally make this call as we can’t declare someone dead…

The worry is overstated. There is no obligation to provide care that is futile (Airedale NHS Trust v Bland [1993] 1 All ER 821). Further health practitioners cannot be compelled to and should not provide care that they think is not indicated by the patient’s condition, and CPR is not indicated where a patient is clearly dead (see Paramedics withholding futile treatment (June 14, 2019)).

A nurse cannot declare a person dead or certify the cause of death for various provisions under the Registration of Births Deaths and Marriages Registration Act 1996 (SA) or the Coroners Act 2003 (SA) but that’s quite a different issue to the recognition that the person is, in fact, dead.  The nurses’ evidence of what they observed and why they concluded the patient was dead will be useful evidence in determining both the time and cause of death.

The Code of Conduct for Paramedics says at [1.4]

Treating patients in emergencies requires practitioners to consider a range of issues, in addition to providing best care. Good practice means you should offer assistance in an emergency that takes account of factors such as your own safety, your skills, the availability of other options and the impact on any other patients under your care, and continue to help until your services are no longer needed.

The Good medical practice: a code of conduct for doctors in Australia says something similar. It says (at [3.5]):

Treating patients in emergencies requires doctors to consider a range of issues, in addition to the patient’s best care. Good medical practice involves offering assistance in an emergency that takes account of your own safety, your skills, the availability of other options and the impact on any other patients under your care; and continuing to provide that assistance until your services are no longer required.

There is no equivalent paragraph in the Code of Conduct for Nurses but the principles set out in the Codes for Paramedics and Medical Practitioners are applicable to nurses.  Importantly none of those codes imposes an obligation upon health practitioners to assist.

There is no duty to rescue so there is no duty to provide CPR. If there is no duty to provide CPR there can be no breach of duty for failing to provide CPR.  Even if there was some allegation of default, the issue would be whether the decision was ‘reasonable’.  If the person has injuries that are incompatible with life.

In response to the question, people have raised the good Samaritan legislation. The Civil Liability Act 1936 (SA) s 74(2) says:

A good samaritan incurs no personal civil liability for an act or omission done or made in good faith and without recklessness in assisting a person in apparent need of emergency assistance.

One could argue that by declining to do CPR the nurse is not ‘assisting a person in apparent need of emergency assistance’. It could, on the other hand, be argued that by declining CPR and more importantly encouraging others not to do CPR the nurse is ‘assisting’ the person by trying to retain their dignity by not subjecting them to treatment that is obviously futile.

More importantly the Act will have no application as it can only apply if there is a duty to act.  In the absence of a duty to act there can be no liability for refusing to act.

Conclusion

In short, registered nurses can ‘decide against providing CPR in the community, both as bystanders or as part of the GoodSAM app as a responder, if the patient has clear signs of death that would not be responsive to CPR such as rigor mortis.’  Any legal conclusion to the opposite would require health professionals to provide care that is not indicated, contrary to good practice and futile. 

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.