Talking about resuscitation
End of life CPR (cardiopulmonary resuscitation), is understandably a very emotional subject that people often feel uncomfortable talking about.
Even if you appreciate the value of speaking to loved ones about their preferences for end of life CPR, having a conversation with those close to you can be extremely difficult. However, talking about CPR can help ensure your loved one’s choices will be observed. Having the conversation can also be one of the most respectful ways to support them through a difficult time.
CPR can be a crucial lifesaving tool, and it’s vital that we educate ourselves on how to confidently carry it out. Sadly, people’s perception of CPR is often influenced by what they have seen on TV. Medical dramas regularly show individuals making full and quick recoveries following successful CPR. But in reality, this is not always the case.
So, if you’d like to better understand a loved one’s feelings about end of life CPR or you think it would help you all to know more facts about resuscitation, here are some things to think about when beginning a conversation.
1. Start talking about things earlier
Beginning the conversations early gives your loved one time to think about what they want. It also gives you and other family members the time to discuss things together. If your relative is living with dementia talking as soon as possible means they may be more able to make choices about their care.
2. Approach it in the right way
It can be a little too direct to ask, ‘Do you want to have CPR?’ Instead, you could ask about your loved one’s preferences around the question: “Are there any circumstances where you would want to refuse CPR?’
3. A natural end of life
End of life resuscitation has a different context to emergency resuscitation. So, it may be helpful to explain to your loved one that although CPR can sometimes be effective when a person's heart and breathing stops prematurely (e.g.: when choking); in their circumstances their heart and breathing will stop because they have reached the natural end of their life.
4. End of life dignity
Dignity is often a key concern for patients at the end of their lives, yet CPR can be incredibly traumatic and invasive. By gently explaining what CPR entails you will be giving them to the chance to exercise control over their care. Make it clear that they will still receive other treatments and care for their condition.
5. Naturally no treatment
It may be that your loved one wishes to refuse any treatment at the end of their life. An ADRT or advance decision to refuse treatment can be discussed and decided upon as part of your conversation. It’s important to make sure such preferences are shared with close family members and carers to ensure their wishes are carried out correctly even if they are unable to communicate them at a later stage.
A time and a place for CPR
CPR can be attempted on anyone, but in some instances, CPR may not be in your loved one’s best interests. Not many people know that the chance of survival following cardiopulmonary resuscitation in adults is between 5-20% depending on the circumstances. So, it may be appropriate to consider another end of life choice - a DNACPR, or Do Not Attempt CPR. A decision that can support their desire to die with dignity.
When someone chooses DNACPR it’s important to share this decision with everyone involved, from medical staff to relatives and the earlier you can make people aware of their choice, the better. Being open about such decisions means that a mutual consensus can be reached, and real peace of mind can be given to the people that matter at such an important time in their lives.
Their end of life, their way
If your loved one feels that a DNACPR decision is right for them and you want to make it clear to the healthcare professionals involved in their care, then an Electronic Palliative Care Coordination System (EPaCCS) will help ensure that no inappropriate CPR attempts will be made.
If you have found yourself affected by bereavement and are struggling with grief, Benenden Health members can call the Mental Health Helpline. The helpline can offer 24 hour support from a qualified therapist during this difficult time.