Heart Failure Asking the Doctor to Make Sure Nobody Resuscitates Him — Free SCA Practice Case

Character Overview: You are Gordon, a 64-year-old restaurant owner with heart failure. You have booked this appointment because you want a decision put in place that you should not be resuscitated if your heart stops. This follows your brother's experience — he had a cardiac arrest, was resuscitated, but was left with a severe brain injury and now has no meaningful quality of life; you find it deeply distressing and describe him as "left a vegetable". You feel very strongly and have thought about it carefully. You have not discussed it with your wife or your two sons. You are calm and articulate. If the doctor engages with you respectfully and explains things (including involving your family), you are open to their guidance; if the doctor is evasive or uncertain, you press to have the form signed today.

Opening Sentence: "Thanks for seeing me, Doctor. I want to sort something out — if my heart ever stops, I do not want anyone trying to resuscitate me. I've thought about it a lot and I want it put in writing so it's clear."

History if Asked (Data Gathering Phase)

• ●Why now / the trigger: "My brother had a cardiac arrest, they brought him back, but he was left with a severe brain injury — no real quality of life. It broke me, seeing it. I never want that for myself."
• ●How settled the decision is: "I've thought about it carefully. It's not a whim. I feel very strongly about it."
• ●His health: "I've got heart failure, managed with tablets. I know it can get worse over time."
• ●Family: "I've not talked to my wife or my sons about it yet."
• ●What he wants: "I want the do-not-resuscitate form done, please."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

• ●Ideas: Gordon understands CPR involves chest compressions and may not restore a good quality of life. "I know CPR is chest compressions and it doesn't always bring people back the way they were."
• ●Concerns: His dominant concern is surviving with a poor quality of life, like his brother. "My fear is being brought back but left like my brother — that terrifies me."
• ●Expectations: He wants a DNACPR form completed. "I want it in writing that I'm not for resuscitation."

If Asked — Understanding, Context, and Wishes Screen

The patient answers these only when directly asked.

• ●If asked, sensitively, how he is coping with his brother's situation: "It's been very hard. But this decision isn't me being depressed — it's a considered choice."
• ●If asked about his mood / whether this is a considered decision vs a grief reaction: "My mood's okay. I'm not depressed or acting on impulse — I've genuinely thought it through."
• ●If asked about his understanding of CPR (what it involves, outcomes, chance of good recovery): "Chest compressions, maybe shocks. I know the odds of walking away unharmed aren't great, especially if you're unwell."
• ●If asked about his heart failure and prognosis: "It's stable for now, but I understand it's a condition that can deteriorate."
• ●If asked about whether he's told his family: "No, not yet. I suppose I should."
• ●If asked about other treatments (would he still want antibiotics, hospital care, etc.): "Oh yes — I'd still want treating for other things. It's only resuscitation I don't want."
• ●If asked about any advance decisions/planning already in place: "Nothing formal yet — that's why I'm here."
• ●If asked about the questions he wants answered: "Is it legally binding? Could another doctor overrule it? And does it mean I wouldn't be admitted to hospital for other things?"

Responses to Management (The Negotiation Phase)

• ●If the Doctor explores his reasoning empathically: "Thank you for actually listening. It means a lot that you understand why." (The tested point is exploring the reasoning and emotional context with empathy.)
• ●If the Doctor explains CPR, DNACPR, ReSPECT, and advance decisions accurately: "So a DNACPR records the recommendation, and an advance decision is the legally binding refusal? I didn't realise there was a difference." (The tested point is accurately explaining and distinguishing DNACPR/ReSPECT/ADRT.)
• ●If the Doctor corrects the "no other treatment" misconception: "So it only applies to resuscitation — I'd still get treated and admitted for anything else? That's reassuring." (The tested point is correcting the common misconception that a DNACPR withholds other care.)
• ●If the Doctor encourages involving his family: "You think I should talk to my wife and sons? I can see why — I'll do that." (The tested point is sensitively encouraging family involvement.)
• ●If the Doctor explains the process/documentation: "So we document my wishes properly and review it, and it's shared with the ambulance service and hospital?"