Living will (advance decision)
Do not resuscitate (DNR) forms and CPR decisions
What is a DNR (do not resuscitate) form?
DNR (do not resuscitate) forms are used to communicate that a decision has been made not to attempt CPR (cardiopulmonary resuscitation).
They are a helpful way to protect people from being given CPR inappropriately.
The official term is DNACPR (do not attempt cardiopulmonary resuscitation), and the forms are also sometimes called DNAR (do not attempt resuscitation).
How DNR (do not resuscitate) decisions are made
If a healthcare professional starts a conversation with you or a relative about DNR forms, this means they might think CPR will do more harm than good.
Your doctor should
- explain why they want to discuss CPR with you (or a relative if you cannot communicate)
- ask what your priorities are, and what outcomes you want to avoid
- explain if they think CPR is medically appropriate or not
A healthcare professional might decide that CPR is not appropriate for someone who:
- is frail
- has a serious illness and is near the end of life
- does not want their life artificially prolonged
DNR forms are only used to prevent people from being given inappropriate CPR. The person should still be given all other treatments to keep them pain free and comfortable.
Cardiopulmonary resuscitation (CPR)
Cardiopulmonary resuscitation (CPR) is an emergency treatment used to attempt to restart a person’s heart and/or breathing.
CPR can include:
- chest compressions (pressing down hard on the chest repeatedly)
- electrical shocks to stimulate the heart (sometimes more than once)
- injections of medicine
- artificial ventilation of the lungs
It does not cure any underlying illnesses, for example heart disease, cancer or frailty. CPR can also leave someone with serious long-term effects which they may never recover from including:
- brain damage
- broken ribs
- loss of independence
- needing long-term care
CPR will successfully restart the heart and breathing for between 1 and 2 out of 10 people.
Even if CPR is successful at restarting the heart and breathing, there are some situations where it may do more harm than good.
If a healthcare professional decides CPR is not medically appropriate, they will record this decision in your medical records, usually on a special form that other healthcare professionals will recognise. They should discuss this with you.
How to question a DNR (do not resuscitate) decision
If you are not sure why a decision about DNR has been made you should ask the person in charge of your care to explain. If you disagree with the decision you can ask for a second opinion.
It can be upsetting to find out that a healthcare professional has decided CPR is not medically appropriate for you or a relative. For many people this first conversation can feel unexpected, but if a healthcare professional brings it up this probably means they think CPR will do more harm than good.
Unfortunately we know DNR decisions are not always explained. This does not necessarily mean it is the wrong decision, but the reasons for the decision have not been communicated properly.
DNR decisions must always be based on the health and priorities of each individual. There must not be blanket policies that apply DNR decisions to groups of people.
How to get a DNR (do not resuscitate) form
If you do not want CPR, you can ask your GP or the person in charge of your care to record this decision in a DNR form.
You can only get a DNR form from a healthcare professional.
What to do next
- Make an appointment with your GP
- You may need to explain your reasons for wanting to refuse CPR, so think about what you might say in advance
- Think about other ways you can record your decisions in writing, for example by making a living will (advance decision)
Decisions about CPR can be recorded in different ways. Your doctor might use a DNR form or another process like ReSPECT.
How to make sure a DNR (do not resuscitate) form is valid
There are different versions of DNR forms in the UK. If you have questions about what address should be on the form, who needs to sign, or if an old form is still valid you can ask your GP.
If you move into a new care setting, for example to a care home, you can ask if your current form is valid.
In an emergency
In most situations CPR will be attempted unless there is a clear DNR in place.
If you have a DNR form, your doctor should share it with the wider clinical team, this may include:
- out of hours team
- local hospital
- local ambulance trust
- GP surgery
If you are worried that your DNR form will not be found, you can speak to your GP.