End-of-life care: 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.
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, see the topic
Writing 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. For more information, see the
topic
Writing an Advance Directive.
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.”
Have more than one long-term
medical problem. For example, a person with severe
emphysema and
heart failure is less likely to benefit from CPR than
a person with mild emphysema and no other health problems.
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.
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.1
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.
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.
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 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 some 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. In addition, 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 undergone 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.
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 "How well do CPR and life support work?" 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 "Key points to remember." 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 "Key points to remember." 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.
Dunn H (2001). Cardiopulmonary resuscitation. In
Hard Choices for Loving People, 4th ed., pp. 11–16. Herndon, VA: A
and A Publishers.
End-of-life care: Should I receive CPR and life support?
You can use this information to talk with your
doctor or loved ones about your decision.
Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
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, see the topic
Writing 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. For more information, see the
topic
Writing an Advance Directive.
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.”
Have more than one long-term
medical problem. For example, a person with severe
emphysema and
heart failure is less likely to benefit from CPR than
a person with mild emphysema and no other health problems.
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.
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.1
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.
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.
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 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 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 some 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. In addition, 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 undergone 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. Your Feelings
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. Your Decision
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. Quiz Yourself
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 and references
Credits
Author
Bets Davis, MFA
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Shelly R. Garone, MD - Palliative Care
References
Citations
Dunn H (2001). Cardiopulmonary resuscitation. In
Hard Choices for Loving People, 4th ed., pp. 11–16. Herndon, VA: A
and A Publishers.
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.
Dunn H (2001). Cardiopulmonary resuscitation. In
Hard Choices for Loving People, 4th ed., pp. 11–16. Herndon, VA: A
and A Publishers.
If you have health-related questions, always ask your healthcare professional.
This information does not replace the advice of a healthcare professional.
Mercy and Healthwise disclaim any warranty or liability for your use of this information, and this information is not intended to represent the ethical and religious beliefs of Mercy.
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