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How are DNAR forms issued?

If you have a long-term condition or a terminal illness, then someone from your healthcare team should talk to you about what you can expect and what your treatment options are. If it’s likely that you’ll have a cardiopulmonary arrest, then planning what will happen if that situation arises, should form part of your conversation. 

When will a DNAR form be issued?

Your healthcare team will assess whether or not CPR is likely to be successful, for example, whether CPR is likely to restart your heart and breathing.

Normally a DNAR form will be issued if:

  1. Your healthcare team feel that CPR is unlikely to be successful

If your healthcare team think that CPR won’t work then they won’t attempt it. A DNAR form will then be added to your medical records to reflect this. You must be told if this is the case. If you lack capacity to make a decision, for example if you’re unconscious, and it’s decided that CPR won’t be attempted if your heart and breathing stop, then your healthcare team should discuss this decision with your family.

If your healthcare team say that CPR won’t work but you still feel that you would like them to attempt it, you should talk to them about your feelings. Although no one has the legal right to demand a treatment, in reality no healthcare professional would refuse your wish for CPR if there was any possibility of it being successful and you making a healthy recovery from it.

Your healthcare team should also give you the opportunity to ask for a second opinion if you disagree with their decision. You don’t have the legal right to a second opinion but a doctor will rarely refuse to refer you for one.

  1. Your healthcare team feel that it’s unclear whether or not CPR would be successful and, following a discussion with them, you decide that you don’t want CPR

If your healthcare team are unsure if CPR will work then they’ll need to decide if it would be in your best interests.

Attempting resuscitation would be in your best interests if, for example, it might mean that you could enjoy your life for a longer amount of time. However, sometimes when CPR is given people need to spend a long time in intensive care, or are left severely disabled by brain damage due to poor blood supply during the cardiopulmonary arrest. In these circumstances attempting CPR might not be in your best interests.

Your opinion is very important in making this decision and someone from your healthcare team will talk to you about what your preferences are. If a decision is made not to attempt CPR, then a DNAR form will be added to your medical records to reflect this.

You don’t have to talk about CPR if you don’t want to, and you shouldn’t be put under pressure to make a decision. If your heart and breathing stop and you haven’t told your healthcare team what you want, then they’ll decide whether to attempt CPR. They’ll base their decision on the likelihood of CPR being successful and on the likelihood of you making a healthy recovery afterwards.

DNAR forms and your rights

In 2014, there was an important court case involving a woman who had a DNAR form placed on her medical records without being consulted. The court ruled that the doctors were wrong not to include the patient or her family in the discussion, and that doctors should speak to patients before a DNAR form is put on a person’s medical records.

The judges also said that a patient getting distressed and upset can’t be used by a doctor as a reason to avoid discussing the DNAR form with them. The only time a doctor has a good reason for not consulting a patient is if the conversation would risk causing them physical or psychological harm.

The Resuscitation Council has issued guidance in response to the case. The guidance stresses the need for doctors to have clear and honest discussions with patients about CPR and the likelihood of its success. Records should be kept of these conversations.