Making CPR decisions

Your view about whether you would like cardiopulmonary resuscitation (CPR) to be attempted is important. Ideally you would be able to talk this over with your family and healthcare team and come to a decision before a cardiac or respiratory arrest occurs. But if you haven’t made a decision then your doctor will decide based on medical grounds.

If you don’t want CPR to be attempted your decision is final. If you insist you would like CPR to be attempted, your healthcare team will take your wishes into account. But a senior doctor can decide not to attempt CPR if they feel it’s not appropriate.

If you haven’t made a decision about CPR and you do experience a cardiac or respiratory arrest your doctors will discuss CPR with your family or next of kin. They will try to find out your views on CPR and make a medical decision based on this.

Once you have made your decision, the doctor will tell the rest of the healthcare team. This information is confidential.

Making decisions about CPR

You may need time to think about your situation carefully. Talk to your healthcare team if you are unsure about anything. It may also help to talk to your family and friends.

You will usually make a decision about CPR with someone from your healthcare team, such as your GP, cancer doctor or specialist nurse. They will tell other members of the team that CPR has been discussed with you and what decision has been made. This information is confidential. It will only be shared with the team caring for you.

If you have told your healthcare team that you don't want to be given CPR, they will accept your decision. Very rarely, the healthcare team may decide that the person is not able to make the decision about CPR themselves. For example, this may happen if a person has a serious mental illness, or is confused or disorientated.

Some people don’t want to make their own decision about CPR. You don’t have to talk about CPR with anyone or decide about CPR. If you prefer, you can let your healthcare team decide for you.

Recording the decision

The decision about CPR will be written clearly in your medical and nursing notes. If the decision has been made not to give CPR, this is written as a 'do not attempt resuscitation' (DNAR) order, or as 'not for resuscitation' (NFCPR). In the medical notes, the doctor usually also writes a date when the decision will be reviewed. This means that the decision will be discussed again to check it is still correct and up to date.

If you are in hospital, the decision will be written in your medical and nursing notes but not in any notes stored beside your bed. If you leave the hospital ward, for example for an x-ray, your medical notes usually go with you. Many hospitals have a system using stickers on the outside of the medical notes to show if CPR should not be given. This helps any person looking after you find this information quickly. As well as the sticker system, your team aims to communicate clearly with staff in other departments. Anyone involved in your hospital care should know about a CPR decision.

If you go home, the community healthcare team looking after you should also be told about a CPR decision. This includes your GP, your local out-of-hours service and the ambulance service. It may also include the community palliative care team, the district nurses and any carers. GPs or community palliative care teams will usually discuss CPR with the people they are looking after. But if they haven’t and you want to discuss it, ask to talk to them. You will keep the written DNAR or NFCPR order in a safe place at home.

If your heart or breathing stops at home and an ambulance is called, the ambulance crew will always give CPR unless there’s a clearly written DNAR or NFCPR order.

If no decision has been made

If no decision has been made and your heart or breathing stops, your healthcare team will make the best decision they can at the time. They will decide whether to give CPR based on your medical situation. In some areas of healthcare, CPR will always be given if a decision has not been made.


Can I insist that I am given CPR?

You may decide that you want to be given CPR even if your healthcare team tells you it is unlikely to work. Your team will consider your wishes about CPR. However, the final decision may be made by a senior doctor.

If you don’t agree with your team’s advice, you can ask for a second medical opinion from another senior doctor. Your doctor or GP can tell you more about getting a second opinion.


What if I am unable to make a decision about CPR?

In some situations, you may not be able to make a decision about CPR. For example, if you are unconscious or too drowsy from medication.

Your healthcare team will make any final decision about CPR. They will think about your medical situation carefully. They will also talk to people close to you, such as your next of kin or family. These people may be able to give an idea of what decision you would make about CPR.

If you have asked your team not to discuss your care with certain people, they will respect this. The team will not discuss the CPR decision with them.

You may have arranged for someone to help make decisions for you if you are unable to. In England and Wales, this person is called a Health and Welfare attorney and must be named in a legal document called a Lasting Power of Attorney (LPA). In Scotland, this person is called a Welfare attorney and the legal document is called a Power of Attorney (PoA).

Your healthcare team must discuss any decision about CPR with your attorney. However, if the healthcare team decides it will do you more harm than good, your attorney can’t demand treatment.

In Northern Ireland, attorneys don’t make decisions about medical treatment. However, your next of kin or relatives should still be asked for advice about the decision.


Recording your decision about CPR in advance

An Advance Decision to Refuse Treatment ADRT (or an Advance Directive in Scotland) is a written statement of your wishes to refuse a particular treatment in a specific situation. It is a way of making sure that everyone knows in advance if there is a treatment you don’t want to have.

Before making an ADRT or AD, it is important to discuss the decisions you’d like to make with one of your healthcare professionals. This may be your GP, or a doctor or nurse specialist looking after you at the hospital. They will be able to tell you what the likely effects of stopping treatment are. They will also make sure your written statement meets legal requirements.

If you decide that you do not want to be given CPR, you can record this in your written statement. A copy can then be put into your medical notes for your healthcare team.


Will a decision about CPR affect the rest of my treatment or care?

A decision about CPR will not affect any other care or treatment that you get.

Each time you are admitted to hospital, a doctor will check the CPR decision and discuss it with you. This is important because your medical condition or decision may change.


What happens if I change my mind about CPR?

You can change your mind about CPR at any time. If you do, it’s important to tell a member of your healthcare team. If you make a new decision with your healthcare team, they will record it in your medical notes. Remember to tell your family or carer about any changes to avoid confusion.

Back to Coping with advanced cancer

Decisions about treatment

You may have lots of questions about your treatment options. You can talk to your doctors and nurses about these.

Who can help?

You can get care and support at home, in a hospital or in a hospice. This depends on your needs and preferences.

What is CPR?

Cardiopulmonary resuscitation (CPR) can be used to try to restart the heart and breathing if they have stopped.