A Difficult Conversation – DNACPR

The decision to refuse life-sustaining treatment or agree to a DNACPR is a difficult one, but it is advisable for individuals think about their wishes and discuss it with their family.

So what is DNACPR?

There are many versions of this you might hear:

DNR – Do Not Resuscitate

DNAR – Do Not Attempt Resuscitation

DNACPR – Do Not Attempt Cardiopulmonary Resuscitation ^{(*most commonly used in UK hospitals)}

But they all amount to the same thing. If you heart stops beating, or you stop breathing, doctors will not try to bring you back to life.

While we most commonly think of chest compressions (the act of pushing vigorously on the chest) as Cardiopulmonary Resuscitation (CPR) it can also include electrical shocks to stimulate the heart, injections of medicine or artificial ventilation of the lungs.

Why are they needed?

There are circumstances where attempting CPR is not in your best interests. Only one in five attempts at CPR in a hospital are successful and where it is successful, the CPR itself can leave you with significant injuries; fractured ribs, damage to your liver and spleen and in the worst cases you could be left brain damaged or in a coma. When someone is near the end of their life in any event, either because they are very elderly or have other medical conditions they are not likely to recover from, it might not be the right decision for that person to go though CPR if it’s not likely to work.

Who makes the Decision?

Everyone has the right to refuse treatment including CPR. If you decide to refuse treatment a DNACPR order is put in your medical records for all doctors to see. You can overturn it at anytime if you change your mind, just have to say.

If you are not able to make the decision whether to receive CPR, either because you do not have capacity or you are not conscious, a decision will be made in your best interests. There will be a discussion with your family, and doctors will seek their agreement to the proposal to withdraw or not offer life-sustaining treatment. In the event that your doctor and your family don’t agree on what is in your best interests, the decision may need to be referred to the Court of Protection, who will hear the evidence from both parties and make the final decision. At all times, the intention is to make the decision that is in your best interests.

In order to avoid the situation where a Court might need to be involved, you can state your own preferences in an Advanced Decision (sometimes called a Living Will). Speak to a Court of Protection solicitor to find out more about making a Living Will.