If you have a loved one who is terminally ill, you may have heard of CPR. CPR stands for cardiopulmonary resuscitation, a medical procedure that tries to restart the heart and lungs when they stop working. CPR can involve chest compressions, mouth-to-mouth breathing, or electric shocks.
You may think that CPR is a miracle that can save anyone’s life, but that is not always the case. CPR is not effective for terminally ill patients, and it can cause more harm than good. Studies show that only about 5% of terminally ill patients who receive CPR survive to leave the hospital. Many of them suffer from brain damage, broken ribs, or infections because of CPR.
This article aims to help you understand the truth about CPR for terminally ill patients. We will debunk ten common myths you may have heard or believed about CPR and provide you with accurate and reliable information. We will also help you make informed and respectful decisions about CPR for your loved one based on their wishes and values.
This article is not meant to discourage you from choosing CPR if that is what your loved one wants or to judge you for whatever decision you make. We know this is an exceedingly difficult and emotional topic, and we want to support you as much as possible. We hope this article will help you and your loved one have a peaceful and dignified end-of-life experience.
Myth 1: CPR always works
Many people believe that CPR can save anyone who stops breathing or whose heart stops beating. However, this is not true. CPR is not always effective and may cause more harm than good. CPR involves pushing on the chest, blowing into the mouth, inserting a tube into the airway, giving electric shocks, and injecting drugs. These procedures can be excruciating and may damage the ribs, lungs, heart, or brain. For people who are terminally ill, CPR is unlikely to restart their heart or breathing and may only prolong their suffering. Studies have shown that the success rate of CPR for terminally ill patients is meager, ranging from 0% to 15%. Most of these patients die within a few hours or days after CPR or end up in a worse condition than before. Therefore, CPR may not be the best choice for people who are dying from a severe illness.
Some may think that CPR is every patient’s right and that doctors must always perform it unless the patient says otherwise. However, this is not true. CPR is not a guaranteed right and may sometimes be withheld or withdrawn. For example, if the patient has a terminal illness and CPR would not improve their quality of life or prolong their dying process, doctors may decide not to do CPR. This is based on the principle of beneficence, which means doing what is best for the patient.
In cases where the doctor or registered nurse assesses that CPR would be futile, a DNR medical order must be written. If there is no DNR order in place at the time of the event, the doctor or registered nurse can document the reasons for refusing to perform CPR effectively.
Myth 3: Patients and families always want CPR
Some people may think that patients and families always want CPR and that refusing or stopping CPR is giving up on life. However, this is not true. Some patients and families may not want CPR or may change their minds for assorted reasons. For example, some patients may have religious or spiritual beliefs that influence their views on CPR and other life-sustaining treatments. They may believe that CPR interferes with the natural process of dying or that it violates their dignity or autonomy. Some patients may also have personal values and goals incompatible with CPR. They may prefer to focus on comfort and quality of life rather than prolonging life at all costs. They may want to die peacefully and naturally without invasive and aggressive interventions. Some patients and families may also change their minds about CPR after learning more about its risks and benefits and the outcomes for terminally ill patients. They may realize that CPR is not a miracle cure and may cause more harm than good. They may also understand that CPR does not guarantee survival or recovery and that most terminally ill patients who receive CPR die within a short time or remain in poor condition. Studies have shown that the preferences and values of terminally ill patients and their loved ones vary widely and that they often differ from those of health care providers. For instance, a survey of cancer patients and their caregivers found that 48% of patients and 37% of caregivers did not want CPR, while only 6% of physicians thought that their patients did not wish to do CPR. Another study of patients with advanced heart failure and their family members revealed that 41% of patients and 50% of family members did not want CPR, while 71% of physicians assumed that their patients wanted CPR. These examples show that patients and families do not always want CPR and that their preferences and values should be respected and honored.
Myth 4: CPR is the only option
Some people may think that CPR is the only option for people who stop breathing or whose heart stops beating. However, this is not true. Other alternatives to CPR may be more appropriate for terminally ill patients. These include comfort care, palliative sedation, and organ donation. Comfort care is a type of care that focuses on relieving pain and suffering rather than trying to cure or prolong life. Comfort care may include medications, oxygen, fluids, and other treatments that make the patient more comfortable. Comfort care can help terminally ill patients die peacefully and with dignity without undergoing painful and futile CPR. Palliative sedation is a type of care that involves giving medications to reduce the level of consciousness of a patient who is experiencing severe and uncontrollable symptoms, such as pain, agitation, or breathlessness. Palliative sedation can help terminally ill patients achieve a state of calmness and comfort without being aware of their surroundings or suffering. Palliative sedation can be used as a last resort when other treatments have failed to relieve symptoms. These examples show that CPR is not the only option for terminally ill patients and that other alternatives may be more suitable and beneficial for them.
Myth 5: CPR is easy to perform and learn
Some people may think CPR is easy to perform and learn and that anyone can do it without proper training. However, this is not true. CPR is a complex and challenging procedure that requires training and practice. CPR involves many steps and skills, such as checking the person’s airway, breathing, and pulse, performing chest compressions and rescue breaths, using an automated external defibrillator (AED), and recognizing when to stop or continue CPR. Performing CPR incorrectly can reduce its effectiveness and cause harm to the person. Some of the common mistakes or complications that can occur during CPR are:
Delaying CPR: Waiting too long to start CPR can reduce the chances of survival and increase the risk of brain damage.
Incorrect hand placement: Placing the hands in the wrong position on the chest can make the chest compressions ineffective or damage the ribs, lungs, or heart.
Inadequate chest compression depth: Compressing the chest too shallowly or too profoundly can reduce the blood flow to the brain and other organs or cause internal injuries.
Not performing CPR long enough: Stopping CPR too soon can prevent the heart from restarting or cause it to stop again.
Breathing into the person’s mouth instead of providing chest compressions: Focusing on rescue breaths instead of chest compressions can reduce blood circulation and oxygen delivery to the brain and other organs.
Not calling for emergency medical services: Failing to call for help or use an AED can delay the arrival of professional care and reduce the chances of survival.
These examples show that CPR is difficult to perform and learn and requires training and practice. Learning CPR from a certified instructor and refreshing your skills regularly is essential. Following the CPR guidelines and avoiding common mistakes and complications is also important. By doing so, you can be better prepared to perform CPR correctly and help save someone’s life in an emergency.
Myth 6: CPR is the same for everyone
Some people may think that CPR is the same for everyone and does not matter the patient’s age, condition, or location. However, this is not true. CPR may vary depending on these factors and require different techniques or equipment. CPR is not a one-size-fits-all procedure, and it should be tailored to the individual needs and circumstances of the patient. Some of the differences or modifications that may apply to CPR for terminally ill patients are:
Age: CPR for children and infants is different from CPR for adults. Children and infants have smaller airways and chests and require less force and depth for chest compressions and rescue breaths. They also have different pulse and breathing rates and may need different doses of medications or shocks. Children and infants are more likely to have respiratory arrests than cardiac arrests, so rescue breaths are more essential for them, too. CPR for older adults may also differ from CPR for younger adults, as they may have more fragile bones, weaker hearts, or chronic diseases that affect their response to CPR.
Condition: CPR for terminally ill patients is different from CPR for patients with acute or reversible causes of cardiac arrest. Terminally ill patients have a poor prognosis and a low chance of survival after CPR and may suffer more harm than benefit from the procedure. They may also have advance directives or DNR orders that indicate their preferences and values about CPR and other life-sustaining treatments. CPR for terminally ill patients should respect their wishes and goals of care and should not be performed against their will or best interests. CPR for terminally ill patients should also consider the quality of life and comfort of the patient and avoid unnecessary pain and suffering.
Location: CPR for patients in different settings may require different resources and skills. CPR for patients in hospitals or clinics may have access to trained staff, equipment, and medications that can improve the chances of survival and recovery. CPR for patients in homes or public places may rely on bystanders, emergency medical services, or AEDs that are not readily available or effective. CPR for patients in remote or rural areas may face longer delays or difficulties in getting professional help or transport. CPR for patients in different locations should consider the availability and quality of the resources and services, as well as the potential benefits and risks of the procedure.
Myth 7: CPR is always consistent with the patient’s wishes
Some people may think that CPR is always consistent with the patient’s wishes and that doctors and family members know what the patient wants and will act accordingly. However, this is not true. CPR may not reflect the patient’s goals or values, and barriers or factors may prevent them from expressing or documenting their wishes. Some of the obstacles or factors that may hinder the patient’s communication or decision-making are:
Lack of information: The patient may not have enough information about CPR, its risks and benefits, and the likely outcomes for terminally ill patients. The patient may also not know about the alternatives to CPR, such as comfort care, palliative sedation, or organ donation. The patient may not have the opportunity to discuss these options with their healthcare providers or loved ones or receive conflicting or confusing information from different sources.
Fear or denial: The patient may be afraid or reluctant to talk about CPR and end-of-life issues, as they may perceive it as giving up hope or accepting death. The patient may also be in denial about their condition or prognosis and may not want to face the reality of their situation. The patient may avoid or postpone having conversations or making decisions about CPR and other life-sustaining treatments.
Emotional distress: The patient may experience emotional distress, such as depression, anxiety, anger, guilt, or sadness, that may affect their judgment or willingness to express their wishes. The patient may also feel pressured or influenced by the emotions of their family members or caregivers, who may have different views or expectations about CPR and end-of-life care.
Cultural or religious beliefs: The patient may have cultural or religious beliefs that shape their views on CPR and end-of-life issues. The patient may believe that CPR is a moral duty, a sign of respect, or a way of honoring God’s will. The patient may also have beliefs about the afterlife, the sanctity of life, or the meaning of suffering that may affect their preferences and values. The patient may not feel comfortable or supported to share their beliefs with their healthcare providers or loved ones or may encounter conflicts or disagreements with them.
Legal or practical barriers: The patient may face legal or practical obstacles that prevent them from expressing or documenting their wishes. The patient may not have access to or awareness of the available tools, such as advance directives, living wills, or health care proxies, that can help them communicate their wishes and appoint a surrogate decision-maker. The patient may also encounter difficulties or delays in completing, updating, or accessing these documents or may not have them honored or respected by their healthcare providers or loved ones.
These examples show that CPR is not always consistent with the patient’s wishes and that barriers or factors may prevent them from expressing or documenting their wishes. It is essential to overcome these barriers and factors and have open and honest conversations about CPR and end-of-life care with the patient and their family members or caregivers. By doing so, you can help the patient make informed and autonomous decisions that reflect their goals and values and provide them with the best possible care and support.
Myth 8: CPR is a one-time decision
Some people may think that CPR is a one-time decision and that once they have made up their minds about it, they do not need to think about it again. However, this is not true. CPR may need to be revisited or revised as the patient’s condition changes and new information or options become available. CPR is not a static or final decision but a dynamic and ongoing process that requires communication and collaboration between patients, their family members or caregivers, and their healthcare team. Some of the scenarios or triggers that may prompt a review or update of the CPR decision are:
A change in the patient’s diagnosis or prognosis: The patient may receive new information about their illness or treatment that may affect their chances of survival or recovery after CPR. For example, the patient may learn that their illness has progressed, worsened, or become incurable, or their treatment has failed, stopped working, or caused severe side effects. The patient may also learn that their life expectancy has shortened or they have developed new complications or symptoms. These changes may alter the patient’s goals or values and make them reconsider whether CPR is still appropriate or desirable.
A change in the patient’s preferences or values: The patient may change their mind about CPR or other life-sustaining treatments based on their beliefs, feelings, or experiences. For example, the patient may witness or hear about the outcomes of CPR for different patients and decide that they do not want to go through the same process or result. The patient may also have a spiritual or religious awakening or a change in their relationships or life circumstances that may influence their views on CPR and end-of-life care. The patient may also discover or develop new interests or passions or fulfill some of their bucket list items that may make them feel more satisfied or at peace with their life. These changes may affect the patient’s quality of life and comfort and make them revise their wishes or priorities about CPR.
A change in the patient’s location or setting: The patient may move to a different place or receive care from a different provider or team with other resources or policies regarding CPR. For example, the patient may transfer from a hospital to a hospice, nursing home, or home care, or vice versa. The patient may also switch from one doctor or nurse to another, consult with a specialist, or get a second opinion. These changes may affect the availability and quality of CPR and other treatments that the patient can receive, as well as the expectations and communication they can have with their healthcare team. These changes may also affect the legal or practical aspects of the CPR decision, such as the validity or accessibility of the advance directives or DNR orders that the patient may have.
These examples show that CPR is not a one-time decision and may need to be revisited or revised as the patient’s condition changes. It is essential to keep the CPR decision up to date and consistent with the patient’s current situation and wishes and to communicate any changes or concerns with the patient’s family members or caregivers and their healthcare team. By doing so, you can help the patient receive the best possible care and support and respect their dignity and autonomy.
Myth 9: CPR is a personal matter
Some people may think that CPR is personal and only concerns the patient and their wishes. However, this is not true. CPR may affect or involve others, such as healthcare providers, family members, or society. CPR is not an isolated or individual decision but a social and ethical issue with implications and consequences for these stakeholders. Some of the impact or consequences of CPR for these stakeholders are:
Health care providers: CPR may have physical, emotional, or legal effects on health care providers who perform or witness it. CPR may cause fatigue, stress, or injury to healthcare providers, especially if they wear personal protective equipment (PPE) or work in challenging environments. CPR may also cause moral distress, anxiety, or guilt to healthcare providers, especially if they have to deal with resuscitation futility, family pressure, or ethical dilemmas. CPR may also expose healthcare providers to legal risks, such as lawsuits, complaints, or sanctions, mainly if they perform CPR incorrectly, against the patient’s wishes, or without consent.
Family members or caregivers: CPR may have emotional, social, or financial impacts on family members or caregivers who witness or participate in it. CPR may cause grief, trauma, or guilt to family members or caregivers, especially if they see their loved one suffer, die, or remain in a vegetative state after CPR. CPR may also cause conflict, pressure, or isolation to family members or caregivers, especially if they disagree with the patient, the health care team, or each other about CPR and end-of-life care. CPR may also cause financial burden, stress, or hardship to family members or caregivers, especially if they have to pay for the medical bills, funeral costs, or long-term care of the patient after CPR.
Society: CPR may have ethical, legal, or economic implications for society. CPR may raise ethical questions or dilemmas, such as who should decide about CPR, when CPR should be started or stopped, and how CPR should be allocated or prioritized. CPR may also create legal issues or challenges, such as protecting the rights and interests of the patient, the family, and the health care providers and resolving disputes or complaints about CPR. CPR may also consume economic resources or costs, such as personnel, equipment, or medications, and the impact on the health care system or the public budget.
These examples show that CPR is not personal and may affect or involve others, such as healthcare providers, family members, or society. It is crucial to consider the implications and consequences of CPR for these stakeholders and to balance the procedure’s benefits and harms for the patient and others. By doing so, you can help the patient receive the most appropriate and respectful care and support the well-being and dignity of all involved.
Myth 10: CPR is the best way to show care
Some people may think that CPR is the best way to show care for a terminally ill patient and that it demonstrates love, hope, or respect. However, this is not true. CPR may not be the most appropriate or compassionate way to support a terminally ill patient, and it may cause more harm than good. CPR may not align with the patient’s wishes or values, and it may violate their dignity or autonomy. CPR may also prolong the patient’s suffering or worsen their condition, and it may reduce their chances of having a peaceful or natural death. CPR may also affect the emotional, social, or financial well-being of the patient’s family members or caregivers, creating conflict, pressure, or guilt. CPR is not the only way to show care for a terminally ill patient; other ways may be more suitable and beneficial for them. Some of the other ways to show care are:
Listening: Listening to patients’ thoughts, feelings, and concerns can help them feel heard, understood, and supported. It can also help patients express their wishes and preferences and make informed and autonomous decisions. Listening can help patients cope with their emotions and fears and find meaning and purpose.
Respecting: Respecting the patient’s wishes and values can help them feel honored and valued. It can also help the patient maintain dignity and autonomy and have control over their care and treatment. Respecting can help patients achieve their goals and priorities and live according to their beliefs and principles.
Comforting: Comforting the patient’s physical and emotional pain and suffering can help them feel relieved and comforted. Comforting can also help patients improve their quality of life and comfort and focus on what matters most to them. Comforting can also help the patient die peacefully and with dignity, without unnecessary interventions or complications.
These examples show that CPR is not the best way to show care for a terminally ill patient and that other ways may be more appropriate and compassionate. It is crucial to consider the patient’s wishes and values, the benefits and harms of CPR, and to balance the care and comfort of the patient and others. By doing so, you can help the patient receive the best possible care and support and respect their dignity and autonomy.
Conclusion
CPR, or cardiopulmonary resuscitation, is a procedure that can help save someone’s life when their heart or breathing stops. However, CPR is not always effective, appropriate, or wanted, especially for terminally ill patients who are dying from a severe illness. There are many myths and misconceptions about CPR that may prevent patients and their family members or caregivers from making informed and respectful decisions about CPR and end-of-life care. In this article, we have debunked ten myths and explained the facts and realities of CPR for terminally ill patients. We hope this article has helped you understand CPR better and make decisions consistent with your goals and values.
If you want to learn more about CPR and end-of-life care, we recommend you talk to your healthcare providers, who can give you more information and guidance on CPR and other options. You can also consult with a palliative care team, who can provide comfort and support and help you cope with your symptoms and emotions. You can also use some tools, such as advance directives, living wills, or health care proxies, to help you communicate your wishes and appoint a surrogate decision-maker. You can also find some resources, such as websites, books, or organizations, that can offer you more education and assistance on CPR and end-of-life care. Here are some examples of these resources:
CaringInfo – Caregiver support and much more – providing resources for advance directives and various guides.
The Conversation Project: This website provides information and tools for discussing your wishes and preferences for end-of-life care with loved ones and healthcare providers.
Five Wishes: This website provides a document that helps you create a personalized living will that covers your medical, personal, emotional, and spiritual needs.
Being Mortal is a book by Dr. Atul Gawande, a surgeon and writer, that explores the issues and challenges of aging and dying and how to improve the quality of life and care for terminally ill patients.
We hope that this article has been helpful and informative for you. We encourage you to think about CPR and end-of-life care and to share your thoughts and feelings with your loved ones and healthcare providers. Thank you for reading this article, and we wish you all the best.
