Our parents are in their late 70’s and have written “No CPR” in their living wills. My sister says they shouldn’t give up without a fight and should have CPR. What’s best for them?
CPR (Cardio-Pulmonary Resuscitation) was developed in 1959 primarily for middle-aged people having a cardiac arrest: the chest is rapidly thumped to compress the heart and circulate blood—which breaks ribs and often the breast bone [just ask first responders and nurses who hear and feel the bones ‘crunching’]—and a tube is put down the throat for breathing. It is a terrible TV-perpetuated myth that CPR is usually successful!!
A futile or non-beneficial procedure was defined recently in the Mayo Clinic Proceedings, as an excessive medical intervention [in terms of effort and finances] with little prospect of altering a patient’s ultimate clinical outcome. Or, more simply, as something that will not help someone achieve their goals.
What is the chance of success? Although different studies show ‘success’ ranges from ‘0’ to 17%, a recent large review found that on average only 8% survived (and it didn’t matter whether they had standard CPR [includes mouth-to-mouth] or the new ‘compression-only’ CPR [no mouth-to-mouth component]) and most ‘survivors’ were worse off and died within the next several months, often in a nursing home. Since most seniors tell me their goal is a peaceful and dignified death; and since CPR is a harsh procedure incompatible with a peaceful end; and since seniors say they do NOT want to end up in a nursing home; then, CPR is definitely futile and inappropriate for them.
Why doesn’t it work? Physiologically, seniors do not have the reserve to deal with such a failure of their organs: they usually have multiple chronic problems and when the heart stops, it’s usually a sign that the body is worn out. CPR offers only false hope when instead we should be helping families to let go of their unrealistic expectations and prepare for life’s final stage.
If they want to avoid this assault and the traumatic memory it leaves families, seniors need to tell their families and put their wishes in their Advance Directive, and tell their doctor and nurse they want an order for AND/DNR (Allow Natural Death / Do Not attempt Resuscitation) written every time they are admitted to a hospital, or any facility. And their families need to honor those wishes!