Making decisions about CPR

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 whether to attempt CPR

Ideally, you’ll be able to discuss your views about CPR with your medical team. You’ll be able to say whether you would, or would not, prefer to have CPR if a cardiac or respiratory arrest occurs. However, it's important to remember that in most situations, and particularly when a cancer is very advanced, CPR is not often successful. Doctors will tell you if they feel there’s little chance of CPR working in your situation.

If there has not been any discussion about CPR between a person and their medical team, and their heart or breathing suddenly stops, the decision about whether or not to attempt CPR is made on medical grounds.

If a person states that they don't want CPR to be attempted, their decision is final. The medical team can only override the decision of the person in very rare circumstances, where the individual is considered not to be of 'sound mind' – for example, if they have a serious mental illness or are confused or disorientated.

Thinking about and discussing CPR can be very difficult. You may want to talk things over with your medical team, specialist nurses, or spiritual carers such as your chaplain or priest.

Some people feel they can't make the decision themselves and may want their doctor to make it for them.

Can I insist that CPR is attempted?

You can certainly express your views about CPR and request that it will or will not be attempted.

If your doctor feels that it’s unlikely to be successful and doesn't believe that CPR should be attempted, you can arrange for a second medical opinion from another senior doctor. Your doctor or GP can advise you about seeking a second opinion.

The healthcare team will take your wishes about CPR into account. However, a senior doctor can ultimately decide not to attempt CPR if, in their clinical judgement, it's not appropriate.

What if I am unable to make this decision?

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

In this situation, doctors would usually discuss CPR with your next of kin or other appropriate relatives. They would try to get an idea about your probable views on CPR from people who know you. Normally, you would need to give your permission before medical staff can discuss any details regarding your medical condition with your family.

In England, Wales and Northern Ireland, although relatives can give their view, any final decision about CPR would be the responsibility of the doctor when the patient is unable to make the decision.

In Scotland, anyone over the age of 16 is allowed to nominate a proxy decision-maker, should they become unable to make the decision themselves. The nominated person must be consulted about treatment decisions, but they can't demand treatment that the doctors feel is unreasonable.

Once the decision has been made

The doctor will inform other members of the healthcare team that CPR has been discussed with you and what decision has been made. This information is confidential and will only be discussed among those caring for you, such as the doctors and the nursing team.

The decision will also be written clearly in your medical and nursing notes, but it will not be documented in the nursing notes at the end of your bed.

If the decision has been made not to attempt CPR, this is written as a 'do not attempt resuscitation' (DNAR) order, or as 'not for resuscitation' (NFCPR). In the medical notes, the doctors will usually document a planned review date, so that this issue is reviewed on a regular basis.

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.