There are differences between Europe and the USA in the style of medical decision-making for patients who are critically ill or requiring CPR. These differences are both legal and philosophical. They concern principally the degree of influence the patient and next of kin should have on critical medical decisions. Currently American physicians transfer more of the decision-making to patients and relatives than do their European counterparts. The current state of the art in cardio-pulmonary resuscitation (CPR) from cardiac arrest occurring out-of-hospital requires public education programmes. These heighten public awareness of CPR-related questions. There has been a wide acceptance in Europe of the American guidelines for CPR. Cultural and legal differences, however, should encourage the acceptance of specific European guidelines. The author believes that it is important to introduce in the European CPR programmes discussions on the ethical dilemmas that may occur. This may help to conserve the relatively high level of public trust that facilitates the patient-doctor relationship in Europe, compared with the USA. Arguments are also put forward for a heightened sensitivity in the European medical profession concerning communication with the patients and their next of kin and with the mass media, in view of the increasing public sophistication and interest that the citizen CPR programmes are generating.