As a nurse in home hospice, I tell each patient at admission that my care is palliative and I don't perform lifesaving measures. The patient then signs an informed consent form acknowledging this policy. My concern is that if I'm with a patient who stops breathing, his family will insist that I initiate CPR. Can I legally refuse?-A.N., N.M.

Indeed, you must. The patient's signature on the form prohibiting lifesaving procedures is legally binding.

The World Health Organization defines palliative care as improving the quality of life of patients and families who face life-threatening illness by providing symptom relief and spiritual and psychosocial support from diagnosis to the end of life and bereavement. Family members who understand this and know what to expect are less likely to insist on CPR or to sue if you refuse.

With your patient's permission, talk to his family about what hospice care means. Keep them informed of the patient's ups and downs to reassure them that he's getting good care.

Consider also creating an agency agreement for relatives of dying patients. It should include an acknowledgment of the patient's consent to withhold lifesaving treatment, an agreement that the family won't interfere with his wishes, and a release of liability for the agency and its employees. If they sign such an agreement, you'll probably avoid a conflict when the patient dies. But whether they sign such a form or not, you must follow the wishes your patient expressed in his consent form.