Your healthcare team should involve you as much as possible when making a decision about CPR. You may need time to think carefully about your situation. Think about what would be best for you if your heart and breathing stopped. Your team will consider your wishes about CPR. However, the final decision will be made by a senior doctor. They will think about the benefits and risks of CPR for you.
They will tell other members of the team that you have discussed CPR 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 do not want CPR, they will accept your decision.
You may decide that you want CPR even if your healthcare team tells you it is unlikely to work. If you do not agree with your team’s advice, you can ask for a second medical opinion from another senior doctor. It is important to be aware that another doctor may have the same opinion as your healthcare team.
Sometimes, the healthcare team may decide that the person is not able to make the decision about CPR themselves. For example, this may happen if someone has a serious mental health illness, or is confused or disorientated.
Some people do not want to make their own decision about CPR. You do not have to talk about CPR with anyone or decide about CPR if you would prefer not to. Instead, 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 a 'not for resuscitation' (NFCPR). The doctor usually also writes a date to review the decision in the medical notes. This means that the decision will be discussed again to check it is still correct and up-to-date. For people with advanced cancer, the doctor may write that the decision is indefinite.
If you are in hospital, the decision will be written in your medical and nursing notes. But they will not be 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 use stickers on the outside of medical notes to show that CPR should not be given. This helps any person looking after you find this information quickly. Your team will also aim to communicate clearly with staff in other departments. Anyone involved in your hospital care should know about a CPR decision.
If you go home from hospital, 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
- the ambulance service.
It may also include:
- the community palliative care team
- the district nurses
- any carers.
Sometimes the DNAR decision will be written on a form that you can take home with you. If you are being cared for at home, check if the community healthcare team will accept the form. You will need to keep it in a safe place at home.
GPs or community palliative care teams will usually discuss CPR with the people they are looking after. But if they have not and you want to discuss it, ask to talk to them.
If no decision has been made
If your heart or breathing stops, your healthcare team will make the best decision they can at the time if:
- you have not already made a decision
- it is not clear what the decision is.
They will decide whether to give CPR based on your medical situation. If your heart or breathing stops at home and an ambulance is called, the paramedics will always give CPR. This is unless there is a clearly written DNAR or NFCPR order.