A 75-year-old man is admitted with pulmonary oedema (fluid in his lungs) due to congestive heart failure (a bad heart resulting in poor pumping abilities). We give him diuretics (water medication to pee out excess fluid). On day three, he suddenly becomes unresponsive and has Cheynes-Stokes breathing, a particular type of breathing pattern associated with severe illness. He also has multiple medical health issues, including COPD (a lung disease related to long-term smoking), hypertension (high blood pressure), diabetes, hyperlipidaemia (high cholesterol), and bowel cancer for which he is not eligible for chemo because of his bad heart.

After emergency work-up including a CT of his brain and a chest x-ray, there isn't anything obviously wrong with him, but clinically he looks awful. His skin is clammy and pale, he still isn't responsive, his breathing is shallow and rapid. I phone the son urgently and tell him his father's in a critical state. With his medical history, there is a high likelihood he will deteriorate rapidly and die tonight, but we will still try our best to treat all reversible causes (currently, giving him diuretics and awaiting blood test results). I advise him to consider a DNACPR because with a heart function that awful and active cancer, if he deteriorates further and goes into cardiac arrest, there is no way we could bring a pulse back, never mind get him better.

"I want him to be comfortable," said the son. OK. We'll continue medical treatment and won't CPR him if he does get worse. "But he has a lot of family that would want to see him, so I want all treatment for him. Including CPR."

Record scratch. What?

Whether his family sees him in time or not will not be affected by the CPR. His family will not be able to see him when CPR is in progress. If they do not see him before he goes into cardiac arrest (and I advise the son that all his family should come ASAP before that happens), they will not be able to see him when we are crushing his ribs because spectators getting in the way and freaking out are the last thing we need when we are doing CPR. They will only be able to see him once CPR is finished, when his chest is caved in and a tube is shoved down his throat. Alternatively, we don't CPR and the family can sit with him as he passes, should it be the time for him to go.

But no, the son still wants everything "because that's my duty as the son". To crush your father's ribs in when it's time for him to go instead of passing peacefully? But it's not my job to argue his flawed decision making with him at 10pm at night, because if the son perceives me advising him strongly against CPR as 'forcing him to give up saving his father', I'm due for a lot of trouble in the future. He wants CPR. Fine. His father gets transferred to a neighbouring hospital with ICU support.

Unrealistic family members like this son just makes the end of life for the patient that much more painful and cruel.