When we, or someone we care about are facing a terminal illness, conversations about end-of-life care can be deeply emotional and difficult to navigate. One of the most misunderstood aspects of emergency care is cardiopulmonary resuscitation, or CPR. Many people assume it’s a guaranteed life-saver — a quick intervention that can bring someone back from the brink. But for people living with a terminal condition, the reality is far more complex.

What Is CPR?

CPR is an emergency procedure used when a person’s heart has stopped beating (cardiac arrest) or they have stopped breathing. It involves chest compressions, sometimes electric shocks (defibrillation), and, in a hospital setting, the administration of medications to try to restart the heart.

CPR Success Rates: The Harsh Truth

Television and film often portray CPR as a highly effective intervention. In reality, survival rates are much lower, especially outside of hospital settings. For people with terminal illnesses — such as advanced cancer, end-stage heart or lung disease, or progressive neurological conditions — the likelihood of CPR restoring meaningful life is extremely slim.

In fact, even when CPR is technically “successful” (meaning the heart restarts), many patients do not survive beyond a few days or may suffer significant complications, including:

• Rib fractures or internal bleeding
• Brain damage due to lack of oxygen
• Prolonged hospital stays in intensive care, often unconscious or unable to communicate

What CPR Can’t Do

It’s important to understand that CPR cannot cure or reverse the underlying illness. For someone whose body is already weakened by disease, CPR may only prolong the dying process, potentially adding distress or pain in the final moments of life.

In the context of terminal illness, attempting CPR can sometimes deny people the peaceful, dignified death they might wish for.

Do Not Attempt CPR (DNACPR) Decisions

In the UK, healthcare professionals may discuss a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision with patients and families. This is not about “giving up” — it’s about recognising when treatment is unlikely to help and may cause more harm than good.

A DNACPR decision simply means that if the heart or breathing stops, CPR will not be attempted. It does not affect any other aspects of care. People will still receive high-quality palliative treatment aimed at comfort, symptom control, and emotional support.

Having the Conversation

Talking about CPR can be uncomfortable, but these conversations are an essential part of planning compassionate and appropriate care. Ideally, these discussions should happen early — not in a crisis. Patients should be supported to understand their choices and to make decisions that align with their values, priorities, and hopes for the end of life.

If you or a loved one are facing a terminal illness, don’t be afraid to ask questions:

• What would CPR involve in my situation?
• What are the chances of it working?
• What might my condition be like if I survive?

Compassion, Not Intervention, at the End of Life

Facing the end of life is never easy, but clear, honest information can empower people to make informed decisions. For many with terminal illnesses, the kindest option is to focus on quality of life rather than aggressive medical interventions that offer little benefit.

By having these conversations openly — with kindness, clarity, and respect — people can approach the end of life with dignity and peace.