Withholding of cardiopulmonary resuscitation: Russian practice and world experience
https://doi.org/10.24884/2078-5658-2026-23-3-62-76
Abstract
Introduction. Cardiopulmonary resuscitation (CPR) – a standard procedure for cardiac arrest, but in some cases, it is not indicated. The «Do Not Resuscitate» (DNR) order has long been practiced in many countries around the world. The study of withholding CPR in the Russian Federation has received little attention.
The objective. To study how the withholding CPR is implemented in Russia, compare it with international practice, identify problems and prospects for their solution.
Materials and methods. Russian legal documents, clinical recommendations, journal articles and Internet resources related to the withholding CPR have been studied. Out of English-language resources on the DNR order, materials were searched that studied problems of withholding CPR similar to those in Russia
Results. In Russia, according to legal acts, withholding CPR is justified in patients with incurable diseases. There are no clear criteria for incurable diseases, which prevents the outright implementation of withholding CPR. The Clinical Guidelines “Cardiac Arrest in Adult Patients” approved by the Federation of Anesthesiologists and Reanimatologists in 2025 (CG) suggest that the council of physicians should decide to refuse resuscitation based on a list of palliative conditions. In many parts of the world, withholding CPR, based on doctors unilaterally established medical futility, is considered unethical. The DNR orders are based on the advanced shared decision by the patient, relatives and doctors to ensure patient’s autonomy.
Conclusion. The proposals of the CG for withholding CPR do not support patient’s autonomy and do not provide reliable legal protection to physicians. It is necessary to start discussion practice of advance care planning including the DNR order.
Keywords
Supporting agencies: The work was carried out with the financial support of the Russian Science Foundation grant, project № 23-18-00400 “Death, dying and donation: an interdisciplinary study of the influence of social factors on the end of life and the development of transplant care.”
About the Author
S. K. Sergienko
City Mariinsky Hospital; Institute of Philosophy of the Russian Academy of Sciences
Russian Federation
Russian Federation
Sergienko Sergei K., Head of Intensive Care Department № 1
56, Liteiny pr., Saint Petersburg, 191014
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Review
For citations:
Sergienko S.K. Withholding of cardiopulmonary resuscitation: Russian practice and world experience. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2026;23(3):62-76. (In Russ.) https://doi.org/10.24884/2078-5658-2026-23-3-62-76
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