CPR Decisions, DNACPR and Living Wills

Living wills, also known as advance decisions and more recently, DNACPR, are becoming increasingly popular solutions for those who want to preemptively refuse emergency life-saving treatment, in the event they stop breathing or their heart stops.

Guides

What does CPR, DNR, DNAR and DNACPR stand for?

The above abbreviation meanings are as follows:

  • CPR meaning ‘cardiopulmonary resuscitation’ that can include one of more of the following emergency life saving measures:
    • Chest compressions
    • Electrical shocks
    • Artificial ventilation
    • An injection of medicine
  • DNR meaning ‘do not resuscitate’
  • DNAR meaning ‘do not attempt resuscitation’ (i.e. CPR)
  • DNACPR is the newest and current abbreviation combining ‘DNAR’ and ‘CPR’ and meaning ‘do not attempt cardiopulmonary resuscitation’.

Within the context of making an advance decision or statement on resuscitation, all of the abbreviations can refer to or mean the same thing.

When is a DNACPR appropriate?

A DNACPR order is appropriate when a patient’s condition means that resuscitation is unlikely to be successful.

There are many reasons why attempts at resuscitation could be considered inappropriate and DNA CPR deemed appropriate.

According to the NHS, CPR is only successful for 1 or 2 in every 10 patients, so to have a good chance of survival and recovery following CPR, you need to be reasonably healthy.

For example, CPR chest compressions can cause broken ribs, punctured lungs and bruising so if you’re particularly vulnerable or frail, such an aggressive life-saving technique could do more harm than good.

And, even if CPR is successful, you could be left with devastating, life-changing injuries like permanent heart or brain damage and may never return to your pre-CPR health or enjoy the same quality of life.

A DNACPR could be appropriate if you:

  • have weak, damaged organs (e.g. smoking-damaged lungs or liver cirrhosis)
  • have a severe long term condition for which there is no cure (does not include disability)
  • have an existing chronic illness (e.g. diabetes, arthritis or hypertension)
  • are frail (weak and vulnerable)
  • are near the end of your life

Who can make a DNACPR order?

There are three different ways in which a DNACPR order can be made, depending on your circumstances.

Healthcare professionals

A healthcare professional can decide it is in your best interests to have a DNACPR order (known as an advance statement).

Historically, a DNAR order could only be issued by a doctor (a GP or hospital consultant) but now other healthcare professionals such as nurses and paramedics can also make an order.

A DNACPR decision by a healthcare professional will typically be recorded on either a:

  • DNACPR form
  • treatment escalation plan (TEP)
  • recommended summary plan for emergency care and treatment (ReSPECT)

Paperwork recording such an important decision will be filed with your medical records and recognised by any medical workers when they view them.

You

As long as you have mental capacity, you can make the decision to refuse CPR by writing either an ‘advance statement’ with the help and input of a doctor. An advance statement is very often written when you’re already quite poorly in hospital.

Alternatively, you can choose at any time to make an ‘Advance Decision to Refuse Treatment’ (ADRT) - more commonly known as a ‘living will’ - with the help of a legal professional (and perhaps the input of a doctor and close family members).

In addition to an advance statement or decision providing instructions not to resuscitate you, these documents can also include additional care-related requirements or information such as:

  • important religious or spiritual beliefs you hold and require strict observance of
  • the location where you’d like to be cared for: at home, a hospital, a hospice or a nursing home
  • your personal hygiene care preferences such as preferring a shower to a bath, or the use of shower gel for sensitive skin instead of soap
  • night-time care such as having 2 pillows or sleeping with the light on
  • dependants: who will look after your dependants (including any pets) when you no longer can

After making a living will make sure you provide a copy of it to your:

  • next of kin
  • GP (and ask them to note the advance decision on your summary care record)
  • hospital consultant (if applicable)
  • carer (if applicable)
  • district nurse (if applicable)

You can also obtain medical ID jewellery from medicalert.org.uk to indicate you have a living will in place.

Make Your Living Will Today

Your Attorney

If you lack mental capacity and already have a Lasting Power of Attorney for health and welfare in place that specifically permits your attorney to make a DNACPR decision, then your appointed Attorney can help to make, along with your healthcare team or doctor, a DNACPR decision on your behalf.

Your Attorney will be presented with all the requisite medical information and will discuss with your healthcare team why this could be the best decision for you.

However, a healthcare professional can override a decision by an Attorney, if they feel this is appropriate.

Also, if you (the LPA donor) made an advance decision (living will) after an LPA was made, your decision cannot be overridden by your Attorney.

If you’d like to know more about our professional LPA services (costing only £175 inclusive of the £82 registration fee), take a look at Why use our professional LPA services

What is the legal status of a DNAR?

The legal status of a DNAR depends on the type of document the DNAR instructions are contained in - an advance statement or an advance decision.

Advance statement legal status

An advance statement is not legally binding but any person who can make a decision about your care, in the event you are not mentally capable, must give consideration to its contents.

If you are of sound mind, you can preemptively decide (along with your family, carers, doctor or social care team), what instructions you’d like to put into an advance statement.

An advance statement is usually written when you are already poorly and vulnerable, and this can be written by a doctor on your behalf (if, say, you’re unconscious).

Advance decision legal status

An advance decision or a DNAR document is legally binding when it is an ‘Advance Decision to Refuse Treatment’ (ADRT) that is signed by you and also signed by a witness to your signature. 

As long as you have mental capacity, an ADRT (living will) is something you can prepare now, confirming your wish to refuse specific life-saving medical treatments in the future.

Breaches of do not resuscitate law UK 2020

A shocking report by England’s care regulator, the Care Quality Commission (CQC), has revealed that during the height of the Covid pandemic, more than 500 patients were put on ‘blanket’ DNAR orders without prior consultation with either the patient, their family or their carers.

The report revealed that in one particular care home “everyone over 80 with dementia had a DNACPR order applied”.

The report also stated that many patients felt unduly pressurised into agreeing to a DNAR order.

CQC also discovered that many relatives felt their loved ones were too vulnerable and lacked the mental capacity to make such an important decision (when they were so poorly with coronavirus) and that a DNACPR order should never have been made without their prior input.

Can a DNR be revoked by family UK?

Whilst a DNR UK (advance statement) cannot usually be revoked by a person’s family in the UK, when a medical professional is making a decision about a DNR order, a doctor must consult with the patient and close family members.

However, there was one particular case where a DNR was successfully revoked that was highlighted during a ‘Do not attempt resuscitation orders: guidelines’ parliament debate on 21 July 2021 by Sir David Amess where he stated:

“Another report was of a 76-year-old man being issued a DNAR order following a heart attack, from which he made a full recovery. The order had not been discussed beforehand, but when his wife protested, she was reportedly told to “let him go with dignity.” The situation was only put right after the intervention of a more understanding member of staff and the order was revoked.”

With this in mind, if you become aware that a DNR order has been made for a close relative without your prior consultation and you do not consider this is right, you should complain.

If a doctor or other medical professional fails to consult with a patient or their family, then relatives may be able to make a claim under Article 8 of the European Convention on Human Rights (ECHR) for the “right to life”. (Note: Despite Brexit, the UK is still a participant in ECHR and so this law continues to apply).

Although a family member should be consulted prior to an ‘advance statement’ being made by a health professional, no family member can revoke or have any influence on an ‘Advance Decision to Refuse Treatment’. An advance decision will have been made by a loved one at an earlier date clearly documenting their wishes and is a legally binding document.