In some cases, the decision about CPR occurs at a time when you might be unable to participate in decision making, and hence cannot voice a preference. There are two general approaches to this dilemma: Advance Directives and surrogate decision makers.

Advance Directive:

In some cases, the decision about CPR occurs at a time when you might be unable to participate in decision making, and hence cannot voice a preference. There are two general approaches to this dilemma: Advance Directives and surrogate decision makers.

Advance Directive:
This is a document which indicates with some specificity the kinds of decisions you would like made should you be unable to participate. In some cases, the document may spell out specific decisions (e.g. Living Will), while in others it will designate a specific person to make health care decisions for you (i.e. Durable Power of Attorney for Health Care). There is some controversy over how literally living wills should be interpreted. In some cases, the document may have been drafted in the distant past, and your views may have changed. Similarly, some patients do change their minds about end-of-life decisions when they actually face them. In general, preferences expressed in a living will are most compelling when they reflect your long held, consistently stable views. This can often be determined by conversations you may have had with family members, close friends, or health care providers with whom you have had long term relationships.

Surrogate decision maker:
In the absence of a written document, people close to you, who are familiar with your wishes, may be very helpful. The law recognizes a hierarchy of family relationships in determining which family member should be the official “spokesperson,” though generally all close family members and significant others should be involved in the discussion and reach some consensus. The hierarchy is as follows:

  • Legal guardian with health care decision-making authority
  • Individual given durable power of attorney for health care decisions
  • Spouse
  • Adult children of patient (all in agreement)
  • Parents of patient
  • Adult siblings of patient (all in agreement)