Do not Resuscitate
DNACPR stands for Do not Attempt Cardiopulmonary Resuscitation. You may have heard it referred to as a DNR (Do not resuscitate) order. DNACPR decisions must be made on a person-by-person basis and must not be made for a group of patients. They are not legally binding but rather are a tool to tell doctors, nurses or paramedics not to attempt CPR.
When might someone need one?
A DNACPR (or DNR) order can be used as part of care planning for seriously ill patients to avoid invasive treatment at the end of life. A DNACPR order is placed in a person’s medical record by a doctor and informs the medical staff that cardiopulmonary resuscitation (CPR) should not be attempted.
CPR is an intervention that tries to get the patient’s heart and breathing going again. It is successful for around 2 in 10 people and is less successful if the heart, lungs or other organs were already struggling. CPR may therefore not be wanted by some people receiving end of life care.
In turn, because CPR is not attempted, other resuscitative measures that follow it (such as electric shocks to the heart and artificial respirations by insertion of a breathing tube) will also be avoided.
Does it mean no treatment at all?
It is important to recognise that a DNACPR order does not mean "do not treat." It means only that CPR will not be attempted. Other treatments that may prolong life such as use of a ventilator can still be provided. Palliative care, treatment to keeps the patient free of pain and comfortable should always be given.
When to discuss and who with
If you or your child is seriously ill, your doctor, should discuss the possibility of cardiopulmonary arrest with you. This is when the heart stops and breathing ceases. They should describe CPR procedures and likely outcomes and ask you about treatment preferences.
Who can make the decision?
Anyone with capacity to make the decision can decide not to receive CPR. You can change your mind about your decision at any time and this will be recorded in the medical records. You can also make this decision before you lose capacity and before you are ill. This is called an Advance Decision to Refuse Treatment (ADRT).
If the patient lacks the capacity to make the decision and/or does not have an ADRT, the doctors are also required to take into account the preferences of anyone with legal authority over their healthcare. This may be a parent or guardian if they are under 16 or a person holding personal welfare deputyship. Another adult already granted Lasting Power of Attorney (LPA) over health and care decisions for the individual who lacks capacity can request the DNACPR order.
A DNACPR is a medical treatment decision and this means that a doctor can also decide if it is appropriate, even if you do not agree. This may be because your organs, or your child’s organs, are already too damaged. You must be informed that this has happened, unless there is a concern that this would lead to physical or psychological harm. You cannot override this but you can request a second opinion.
Further information, including how to complain about a DNACPR order can be found here:
https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/
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