Do not attempt cardiopulmonary resuscitation (DNACPR)

DNACPR stands for “Do Not Attempt Cardiopulmonary Resuscitation”. It is also known as DNAR (Do Not Attempt Resuscitation) or DNR (Do Not Resuscitate), but they all refer to the same thing.

A (DNACPR) decision or DNACPR order means that if your heart or breathing stops, your healthcare team will not attempt to restart them.

When is a DNACPR decision made and who is involved?

This decision can be made by you, your doctor, or your healthcare team. There are different situations when a DNACPR decision might be made, but preferably you want to be in control of your end-of-life decisions. Because there is no-one better to make them.

Deciding in advance to refuse CPR

Everyone who has the capacity to do so can refuse CPR if they wish. This is a choice you can make at any time, whether you are healthy or approaching the end of your life.

Is a DNACPR form legally binding?

A DNACPR form is not legally binding. If you wish to make your DNACPR decision legally binding, you can write an Advance Decision to Refuse Treatment (ADRT). An ADRT explains when you want to refuse CPR (or other treatment).

Wearable ADRT/Do Not Resuscitate order

Once you have made your DNACPR decision, it is recorded in your medical records, typically on a form that healthcare professionals will recognize. However, in emergency situations, a written advance decision form to refuse CPR may not be immediately visible to first responders or they may not know where to locate it.

To address this issue, your Advance Decision to Refuse Treatment (ADRT) for resuscitation can be engraved on a wearable necklace. This ensures that your dnr order is known and accessible even if you are away from your usual healthcare setting.

It clearly states that you do not wish to be resuscitated under any circumstances and can be a crucial tool in emergencies, providing immediate guidance to first responders and medical professionals about your preferences regarding resuscitation efforts.

Who makes an advance decision to refuse CPR treatment?

You make the advance decision, as long as you have the mental capacity to make this decision.

Make sure to consider discussing this with a doctor or nurse familiar with your medical history before making your decision. It may be helpful to talk to a doctor or nurse about the types of treatments you might be offered in the future and what it would mean if you choose to decline them.

Is an Advance Decision Legally Binding?

If you wish to refuse life-sustaining CPR treatment, this needs to be clearly stated in the advance decision. An advance decision may only be considered valid if it:

• Complies with the Mental Capacity Act
• Applies to the situation
• You are 18 years old or older and had the capacity to make, understand, and communicate your decision when you made it
• It clearly specifies to refuse CPR
• It explains you wish to refuse resuscitation under all circumstances
• Include the statement that the treatment is refused ‘even if my life is at risk’
• It is signed by you (and by a witness if you want to refuse life-sustaining CPR treatment)
• You made the advance decision of your own accord, without any harassment by anyone else
• You have not said or done anything since making the decision that contradicts it (e.g., indicating that you have changed your mind)

As long as it is valid and relevant to your situation, an advance decision provides your health and social care team with clear clinical and legal guidance regarding your treatment preferences. This advance decision will only come into effect if, at some point in the future, you are unable to make your own treatment decisions.

CPR (cardiopulmonary resuscitation) is a treatment aimed at restarting breathing and blood flow in individuals who have:

• Stopped breathing (respiratory arrest), or
• Experienced cardiac arrest (their heart has stopped beating)

CPR can involve:

• Chest compressions (repeatedly pressing down hard on the chest)
• Electrical shocks to stimulate the heart (possibly multiple times)
• Injections of medicine
• Artificial ventilation of the lungs

In a hospital setting, approximately 1 in 4 people survive and are discharged after receiving CPR. Survival rates are typically lower in other environments.

The effectiveness of CPR varies and depends on factors such as the cause of the respiratory or cardiac arrest, preexisting medical conditions, and overall health. For some, there may be no benefit from CPR.

Your healthcare team can discuss the likelihood of CPR being successful for you.

Even when CPR is successful, it can lead to serious complications, including:

• Fractured ribs
• Damage to the liver and spleen
• Brain damage, potentially resulting in disability

Survivors of CPR may require intensive medical support afterward, with some needing prolonged treatment in an intensive care unit (ICU).

IMPORTANT

DNACPR is about CPR (Cardiopulmonary Resuscitation) only. It does not mean that you will be denied other types of care and treatment. You will continue to receive all other appropriate care, treatment, and support you need. DNACPR ensures that if your heart or breathing stops, medical staff will not attempt to restart them, but you will still receive comprehensive and compassionate care for all your other medical needs.