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.
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.
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.
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."
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.
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.
|Choose to have CPR and life support||Choose not to have CPR and life support|
|What is usually involved?|
|What are the benefits?|
|What are the risks and side effects?|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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
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.
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.
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.
My other important reasons:
My other important reasons:
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
1. Does CPR always work to "bring someone back"?
2. Is it better to leave this decision to your loved ones?
3. If you say that you don't want CPR and life support, will you still be taken care of?
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Shelly R. Garone, MD, FACP - Palliative Medicine|