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Advance Care Planning: Should I Receive CPR and Life Support


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Advance Care Planning: Should I Receive CPR and Life Support?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Advance Care Planning: Should I Receive CPR and Life Support?

Get the facts

Your options

  • Choose to receive CPR and be put on a ventilator if your heart or breathing stops. Being put on a ventilator is sometimes referred to as "being put on life support."
  • Choose not to receive CPR or life support if your heart or breathing stops.

This information is for you if you have a very serious illness and are trying to decide whether you will want to have CPR and life support when your heart and breathing stop. If you are healthy now but want to be sure that your family and your doctor know what to do if you suddenly become unable to say what you want, you may want to write an advance directive.

Key points to remember

  • If you believe that every possible step should be taken to save life, you may want to choose CPR (resuscitation) and life support. You may not want them if you believe that they would prolong your life artificially and not allow you to die naturally.
  • CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • If CPR does work, you may have brain damage that affects your ability to talk, recognize loved ones, or take care of yourself.
  • Saying "no" to CPR and life support doesn't mean that you won't be taken care of. Doctors and nurses will always focus on making sure that you stay comfortable.
  • Many people would rather leave this decision to loved ones, thinking that "they'll know what I would want." But that's very hard on your family. It's much easier and less stressful for them if you state your wishes clearly ahead of time.
FAQs

What are CPR and life support?

When you learn that you have an illness that is probably going to shorten your life, your doctor may talk to you about receiving care that will help you stay comfortable without prolonging your life. Your doctor may also talk to you about your desire to be revived (resuscitated) when your illness reaches its last stages and your heart and breathing stop.

CPR

If you choose to receive CPR when your breathing or heart stops, someone will push air into your mouth and push down very hard on your chest with his or her hands. CPR stands for cardiopulmonary resuscitation. If you are in the hospital when your breathing or heart stops, a team of doctors, nurses, and others will respond.

In the hospital, the team may use a device called a defibrillator to apply an electrical shock to your heart. The shock may restart your heart. You may also get medicine—through your vein (IV) or down a breathing tube—to help your heart beat again.

Life support

After CPR has been started, you will be connected to a machine called a ventilator or respirator. A tube is placed down your throat and then connected to the ventilator. The ventilator pumps oxygen through the tube into your lungs. Being placed on a ventilator is referred to as "being put on life support."

How well do CPR and life support work?

When a person's heart stops, CPR may work to start it again but often only for a short time. Only 10 to 15 out of 100 people live long enough to leave the hospital after they have had CPR. For elderly people and those with serious illnesses, less than 5 out of 100 people who have had CPR will live long enough to leave the hospital.1

But CPR, life support, or both may work for some people. If you are generally healthy, CPR and life support may offer you the chance to return to your normal activities.

Even when a person has a long-term fatal illness, death can happen suddenly. If you choose to have CPR and life support, you may be able to live a little longer—sometimes a few hours, or even a few days or more.

If you are very ill, you may feel that CPR would just prolong the dying process. On the other hand, if you feel that you need to do everything you can to live in spite of the limits caused by your illness, you may choose CPR.

What are the risks of CPR and life support?

  • CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • Pressing on the chest during CPR often breaks the person's ribs.
  • People who do survive after their heart has stopped may have brain damage. This can affect your ability to talk, recognize loved ones, dress yourself, or manage your bathroom needs.
  • With CPR and life support, you may live longer than you would without life support. But your remaining time may be spent in a hospital connected to machines.
  • If CPR does "bring you back," you will still have your chronic illness plus the new problems that led to your needing CPR in the first place.
  • If you don't make your wishes known, your doctor and loved ones may face some tough decisions. In an emergency, you would probably receive CPR. Then you could be placed on life support , even if you didn't want it. Your doctor and family may have a hard time deciding how to continue your medical care. Also, it may be very hard for your loved ones to decide when to stop life support.

How do you make your wishes known?

If you do not want to have CPR and life support, make it very clear to your doctor and family.

Many states require a doctor's order to release paramedics and others from their duty to start CPR. Ask your doctor about a "Do Not Resuscitate" order.

Be specific about your wishes. Share your feelings about not wanting to prolong your life. This time can be a chance to share memories, nurture your relationships with others, and say good-bye. If your death happens quickly and unexpectedly, your family may feel assured that you received the medical care you wanted and that you died the way you wanted.

What is an advance directive?

An advance directive is your personal statement of how medical care choices should be made and who should make them if you become unable to speak for yourself. A medical power of attorney, which appoints someone to make treatment decisions for you, and a living will are types of advance directives.

You can also write an advance directive for a Do Not Resuscitate (DNR) order. It tells hospital workers that you don't want CPR if your heart stops or you stop breathing. Your doctor can put the DNR order on your medical chart for everyone to see.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Choose to have CPR and life support Choose to have CPR and life support
  • When your heart stops, someone pushes on your chest or uses a defibrillator to try to get your heart started again.
  • When your breathing stops, someone breathes into your mouth or pushes air into your lungs.
  • When your heart has restarted but you can't breathe on your own, you are connected to a breathing machine called a ventilator through a tube down your throat.
  • In a few cases, CPR and life support can restore your ability to breathe on your own and, over time, return to your normal activities.
  • CPR and life support may help you live longer, although you may have to stay connected to machines.
  • CPR doesn't always work to resuscitate people, or "bring them back."
  • If CPR does work, you may have brain damage that affects your ability to talk, recognize loved ones, or take care of yourself.
  • Chest compressions from CPR often cause broken ribs.
  • You may live longer, but your remaining time may be spent in a hospital connected to machines.
  • If CPR does work, you'll still have your illness plus new problems that led to your needing CPR in the first place.
Choose not to have CPR and life support Choose not to have CPR and life support
  • When your heart stops or you stop breathing, doctors and nurses allow you to die naturally. They don't try to revive you.
  • Hospital workers will make sure you are as comfortable as possible.
  • Your death may be more calm and peaceful than it would be if you were connected to machines.
  • Your death will be more natural, because you will not be relying on machines to keep you alive.
  • You may die sooner than you would if you had chosen to have CPR and life support.
  • If you die suddenly, you may miss a chance to say good-bye to loved ones.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about CPR and mechanical ventilation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

About 3 years ago I was diagnosed with ALS. My disease is progressive and fatal. I am confined to a wheelchair and am also having difficulty swallowing. At some point, I will no longer be able to breathe on my own. When that time comes, I wish to die peacefully. I do not want to be held captive by machines, nor do I want to put my family through the agonizing position of trying to decide when to remove life support.

Juan, age 61

My chronic obstructive pulmonary disease is very unpredictable. I understand that my illness is progressive and most likely will lead to my death. Even though I have frequent bouts of pneumonia, each episode has been treatable and I have been able to resume my life. I was on a ventilator with one of my previous bouts with pneumonia. In this case, the pneumonia was treated and I was weaned off the machine. I feel my life is worth living, even with COPD, and I am not willing to forgo aggressive life-sustaining medical care just because I have an incurable illness.

Rex, age 57

I have been living with heart disease for 20 years. Also, I have problems with skin sores because of my diabetes. My doctor has talked to me about the possibility that my heart may stop at any time. He asked me about whether I want to have CPR done if my heart stops beating. We also talked about whether I want to be hooked up to machines to keep me alive. If my heart stops suddenly, I do not want 911 called. I definitely do not want to be connected to life support! When my time comes, I want to go quickly and calmly. I do not want to live my final days in a hospital hooked to machines. This seems too cold and undignified.

Grace, age 79

It was just about 18 months ago that I was diagnosed with a brain tumor. I have had surgery, radiation, and chemotherapy, but my tumor has reappeared. My family and I have discussed the probability of my death, and we are ready to call 911 if an emergency arises. Aside from my brain tumor, my health is excellent. If I should choke or get in an accident, I still want emergency services called and CPR performed. I am even willing to be placed on a ventilator if my condition has any chance of improving.

Yao, age 36

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose CPR and life support

Reasons not to choose CPR and life support

I want my doctors and nurses to do everything possible to keep me alive for as long as possible.

I want to have a calm, peaceful death that doesn't involve being connected to machines.

More important
Equally important
More important

I need more time to say good-bye and to make plans for my death.

I have made peace with my friends and loved ones and have made plans for my death.

More important
Equally important
More important

I might need CPR for some other emergency that isn't related to my fatal illness.

My illness is far enough along that I'm not worried about any other emergencies that could happen to me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Choosing CPR and life support

NOT choosing CPR and life support

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does CPR always work to "bring someone back"?

  • YesNo, that's wrong. CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • NoYou're right. CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • I'm not sureIt may help to go back and read "Get the Facts." CPR doesn't always work to resuscitate people, or "bring them back."
2.

Is it better to leave this decision to your loved ones?

  • YesSorry, but that's wrong. Although it may seem simpler to put this decision off, it's much easier and less stressful for your family if you state your wishes clearly ahead of time.
  • NoYou're right. Although it may seem simpler to put this decision off, it's much easier and less stressful for your family if you state your wishes clearly ahead of time.
  • I'm not sureIt may help to go back and read "Get the Facts." Although it may seem simpler to put this decision off, it's much easier and less stressful for your family if you state your wishes clearly ahead of time.
3.

If you say that you don't want CPR and life support, will you still be taken care of?

  • YesThat's correct. Even if you say "no" to CPR and life support, your doctors and nurses will always focus on making sure that you stay comfortable.
  • NoNo, you're wrong. Even if you say "no" to CPR and life support, your doctors and nurses will always focus on making sure that you stay comfortable.
  • I'm not sureIt may help to go back and read "Get the Facts." Even if you say "no" to CPR and life support, your doctors and nurses will always focus on making sure that you stay comfortable.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerShelly R. Garone, MD, FACP - Palliative Medicine

References
Citations
  1. Pan CX (2008). Palliative medicine. In EG Nabel, ed., ACP Medicine, Clinical Essentials, chap. 9. Hamilton, ON: BC Decker.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Advance Care Planning: Should I Receive CPR and Life Support?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Choose to receive CPR and be put on a ventilator if your heart or breathing stops. Being put on a ventilator is sometimes referred to as "being put on life support."
  • Choose not to receive CPR or life support if your heart or breathing stops.

This information is for you if you have a very serious illness and are trying to decide whether you will want to have CPR and life support when your heart and breathing stop. If you are healthy now but want to be sure that your family and your doctor know what to do if you suddenly become unable to say what you want, you may want to write an advance directive.

Key points to remember

  • If you believe that every possible step should be taken to save life, you may want to choose CPR (resuscitation) and life support. You may not want them if you believe that they would prolong your life artificially and not allow you to die naturally.
  • CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • If CPR does work, you may have brain damage that affects your ability to talk, recognize loved ones, or take care of yourself.
  • Saying "no" to CPR and life support doesn't mean that you won't be taken care of. Doctors and nurses will always focus on making sure that you stay comfortable.
  • Many people would rather leave this decision to loved ones, thinking that "they'll know what I would want." But that's very hard on your family. It's much easier and less stressful for them if you state your wishes clearly ahead of time.
FAQs

What are CPR and life support?

When you learn that you have an illness that is probably going to shorten your life, your doctor may talk to you about receiving care that will help you stay comfortable without prolonging your life. Your doctor may also talk to you about your desire to be revived (resuscitated) when your illness reaches its last stages and your heart and breathing stop.

CPR

If you choose to receive CPR when your breathing or heart stops, someone will push air into your mouth and push down very hard on your chest with his or her hands. CPR stands for cardiopulmonary resuscitation. If you are in the hospital when your breathing or heart stops, a team of doctors, nurses, and others will respond.

In the hospital, the team may use a device called a defibrillator to apply an electrical shock to your heart. The shock may restart your heart. You may also get medicine—through your vein (IV) or down a breathing tube—to help your heart beat again.

Life support

After CPR has been started, you will be connected to a machine called a ventilator or respirator. A tube is placed down your throat and then connected to the ventilator. The ventilator pumps oxygen through the tube into your lungs. Being placed on a ventilator is referred to as "being put on life support."

How well do CPR and life support work?

When a person's heart stops, CPR may work to start it again but often only for a short time. Only 10 to 15 out of 100 people live long enough to leave the hospital after they have had CPR. For elderly people and those with serious illnesses, less than 5 out of 100 people who have had CPR will live long enough to leave the hospital.1

But CPR, life support, or both may work for some people. If you are generally healthy, CPR and life support may offer you the chance to return to your normal activities.

Even when a person has a long-term fatal illness, death can happen suddenly. If you choose to have CPR and life support, you may be able to live a little longer—sometimes a few hours, or even a few days or more.

If you are very ill, you may feel that CPR would just prolong the dying process. On the other hand, if you feel that you need to do everything you can to live in spite of the limits caused by your illness, you may choose CPR.

What are the risks of CPR and life support?

  • CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.
  • Pressing on the chest during CPR often breaks the person's ribs.
  • People who do survive after their heart has stopped may have brain damage. This can affect your ability to talk, recognize loved ones, dress yourself, or manage your bathroom needs.
  • With CPR and life support, you may live longer than you would without life support. But your remaining time may be spent in a hospital connected to machines.
  • If CPR does "bring you back," you will still have your chronic illness plus the new problems that led to your needing CPR in the first place.
  • If you don't make your wishes known, your doctor and loved ones may face some tough decisions. In an emergency, you would probably receive CPR. Then you could be placed on life support , even if you didn't want it. Your doctor and family may have a hard time deciding how to continue your medical care. Also, it may be very hard for your loved ones to decide when to stop life support.

How do you make your wishes known?

If you do not want to have CPR and life support, make it very clear to your doctor and family.

Many states require a doctor's order to release paramedics and others from their duty to start CPR. Ask your doctor about a "Do Not Resuscitate" order.

Be specific about your wishes. Share your feelings about not wanting to prolong your life. This time can be a chance to share memories, nurture your relationships with others, and say good-bye. If your death happens quickly and unexpectedly, your family may feel assured that you received the medical care you wanted and that you died the way you wanted.

What is an advance directive?

An advance directive is your personal statement of how medical care choices should be made and who should make them if you become unable to speak for yourself. A medical power of attorney, which appoints someone to make treatment decisions for you, and a living will are types of advance directives.

You can also write an advance directive for a Do Not Resuscitate (DNR) order. It tells hospital workers that you don't want CPR if your heart stops or you stop breathing. Your doctor can put the DNR order on your medical chart for everyone to see.

2. Compare your options

Choose to have CPR and life support Choose not to have CPR and life support
What is usually involved?
  • When your heart stops, someone pushes on your chest or uses a defibrillator to try to get your heart started again.
  • When your breathing stops, someone breathes into your mouth or pushes air into your lungs.
  • When your heart has restarted but you can't breathe on your own, you are connected to a breathing machine called a ventilator through a tube down your throat.
  • When your heart stops or you stop breathing, doctors and nurses allow you to die naturally. They don't try to revive you.
  • Hospital workers will make sure you are as comfortable as possible.
What are the benefits?
  • In a few cases, CPR and life support can restore your ability to breathe on your own and, over time, return to your normal activities.
  • CPR and life support may help you live longer, although you may have to stay connected to machines.
  • Your death may be more calm and peaceful than it would be if you were connected to machines.
  • Your death will be more natural, because you will not be relying on machines to keep you alive.
What are the risks and side effects?
  • CPR doesn't always work to resuscitate people, or "bring them back."
  • If CPR does work, you may have brain damage that affects your ability to talk, recognize loved ones, or take care of yourself.
  • Chest compressions from CPR often cause broken ribs.
  • You may live longer, but your remaining time may be spent in a hospital connected to machines.
  • If CPR does work, you'll still have your illness plus new problems that led to your needing CPR in the first place.
  • You may die sooner than you would if you had chosen to have CPR and life support.
  • If you die suddenly, you may miss a chance to say good-bye to loved ones.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about CPR and mechanical ventilation

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"About 3 years ago I was diagnosed with ALS. My disease is progressive and fatal. I am confined to a wheelchair and am also having difficulty swallowing. At some point, I will no longer be able to breathe on my own. When that time comes, I wish to die peacefully. I do not want to be held captive by machines, nor do I want to put my family through the agonizing position of trying to decide when to remove life support."

— Juan, age 61

"My chronic obstructive pulmonary disease is very unpredictable. I understand that my illness is progressive and most likely will lead to my death. Even though I have frequent bouts of pneumonia, each episode has been treatable and I have been able to resume my life. I was on a ventilator with one of my previous bouts with pneumonia. In this case, the pneumonia was treated and I was weaned off the machine. I feel my life is worth living, even with COPD, and I am not willing to forgo aggressive life-sustaining medical care just because I have an incurable illness."

— Rex, age 57

"I have been living with heart disease for 20 years. Also, I have problems with skin sores because of my diabetes. My doctor has talked to me about the possibility that my heart may stop at any time. He asked me about whether I want to have CPR done if my heart stops beating. We also talked about whether I want to be hooked up to machines to keep me alive. If my heart stops suddenly, I do not want 911 called. I definitely do not want to be connected to life support! When my time comes, I want to go quickly and calmly. I do not want to live my final days in a hospital hooked to machines. This seems too cold and undignified."

— Grace, age 79

"It was just about 18 months ago that I was diagnosed with a brain tumor. I have had surgery, radiation, and chemotherapy, but my tumor has reappeared. My family and I have discussed the probability of my death, and we are ready to call 911 if an emergency arises. Aside from my brain tumor, my health is excellent. If I should choke or get in an accident, I still want emergency services called and CPR performed. I am even willing to be placed on a ventilator if my condition has any chance of improving."

— Yao, age 36

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose CPR and life support

Reasons not to choose CPR and life support

I want my doctors and nurses to do everything possible to keep me alive for as long as possible.

I want to have a calm, peaceful death that doesn't involve being connected to machines.

More important
Equally important
More important

I need more time to say good-bye and to make plans for my death.

I have made peace with my friends and loved ones and have made plans for my death.

More important
Equally important
More important

I might need CPR for some other emergency that isn't related to my fatal illness.

My illness is far enough along that I'm not worried about any other emergencies that could happen to me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Choosing CPR and life support

NOT choosing CPR and life support

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does CPR always work to "bring someone back"?

  • Yes
  • No
  • I'm not sure
You're right. CPR doesn't always work to resuscitate people, or "bring them back." And the older and sicker you are, the less likely it is to work.

2. Is it better to leave this decision to your loved ones?

  • Yes
  • No
  • I'm not sure
You're right. Although it may seem simpler to put this decision off, it's much easier and less stressful for your family if you state your wishes clearly ahead of time.

3. If you say that you don't want CPR and life support, will you still be taken care of?

  • Yes
  • No
  • I'm not sure
That's correct. Even if you say "no" to CPR and life support, your doctors and nurses will always focus on making sure that you stay comfortable.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerShelly R. Garone, MD, FACP - Palliative Medicine

References
Citations
  1. Pan CX (2008). Palliative medicine. In EG Nabel, ed., ACP Medicine, Clinical Essentials, chap. 9. Hamilton, ON: BC Decker.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Revised: May 8, 2013

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Shelly R. Garone, MD, FACP - Palliative Medicine


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