What Will We Need to Decide About Resuscitation?

If someone's heart stops, blood no longer circulates, and the person will die unless the heart is restarted immediately. Since a person's sudden collapse must be addressed so quickly, many people are trained to make the efforts needed to restart circulation right away by using cardiopulmonary resuscitation.

In the case of a seriously ill person, however, cardiopulmonary resuscitation (CPR) may not be what is wanted. It may not be successful. It is rarely effective in those who are very sick, and life after resuscitation can be short and usually involves the use of a ventilator. You and your loved one need to discuss whether or not to have CPR.

If your loved one decides against trying resuscitation, how can you prevent people from trying anyway? Have a direct conversation with the doctor and with others involved in caring for your loved one to be sure that everyone understands what is wanted. If your loved one is in the hospital, his doctor can write a do-not-resuscitate order (DNR) to be added to the medical chart. Medical and emergency staff are not to attempt CPR on a person who has a DNR.

Deciding whether or not to have a DNR order sounds so simple. Yet this decision often causes much anxiety for families and health care providers. Why? Because these decisions are usually put off until the patient is too sick to be a part of the conversation. And making the decision means acknowledging that the patient is likely to die.

Nursing homes follow a similar process, although it may be entrusted to a primary nurse. Ask how your family can ensure that your loved one's wishes are followed. Be clear about whether your loved one should be sent to a hospital if he should become quite ill. If he is at the point that he would want to go to a hospital only to relieve symptoms, or not at all, be sure to make that wish clear.

If your loved one is at home, CPR may be less likely to occur, unless someone panics and calls 911. You can ensure that the emergency crew will follow your loved one's wishes, but you must find out what the process is in your state and follow it.