Resuscitation Council (UK)

Frequently asked questions (FAQs)

Do not Attempt CPR (DNACPR)

Do Not Attempt CPR

Policies and documents for recording decisions about CPR have been established in many areas within the UK. The purpose of a DNACPR decision is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer cardiac arrest or die suddenly.

Not everyone wants to receive attempted CPR, so it is important to respect people’s wishes and to make sure that they are offered a chance to make choices that are right for them.

When someone suffers sudden cardiac arrest due to a sudden problem with their heart, immediate CPR can offer a chance of restoring them to a length and quality of life that they value. 

When someone’s heart and breathing stop because they are dying from an advanced and irreversible condition, CPR will subject them to a vigorous physical intervention that deprives them and those important to them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering.  

Attempted CPR involves rapid, repeated compression of a person’s chest, blowing air or oxygen into their lungs, if necessary by inserting a tube into their windpipe, delivery of high-voltage electric shocks through their chest and injection of drugs. 

CPR is by no means always successful in restarting the heart and breathing. When CPR is shown in films and TV ‘soaps’ they often fail to show the reality of what is involved and of the likelihood of success.

As with any medical treatment, the aim is to offer it in the most effective way to anyone who may benefit from it. For those people, that requires starting CPR immediately, as any delay will reduce their chance of survival. The aim is also to avoid inflicting CPR on people who do not want it or on those who will not benefit from it and may be harmed by it. Making and recording a decision about CPR in advance and communicating it to those who need to know it can help to ensure that, as far as is humanly possible, inappropriate CPR is avoided.

This is a decision not to attempt CPR, made and recorded in advance, to guide those present if a person subsequently suffers sudden cardiac arrest or dies. 

A DNACPR decision may be made and recorded:

  • at the request of the person themselves
  • as a shared decision (made by the person themselves and their doctor and/or other healthcare team members) that the likelihood of CPR being beneficial in their current situation would not outweigh the potential burdens and risks of receiving attempted CPR
  • by the healthcare team, because CPR should not be offered to a person who is dying from an advanced and irreversible condition and therefore CPR will not prevent their death
  • by the healthcare team because the person themselves is not able to contribute to a shared decision and a decision has to be made in their best interests.

If a person is unable to contribute to making the decision (for example because they are unconscious, severely demented, or too severely ill to participate in the discussion) the decision will be made by the senior clinician responsible for their care, whenever possible after taking advice from those close to the person, such as family members. However family members are not expected to or entitled to make the decision unless they have been given legal power (e.g. Power of Attorney) to make such decisions on the person’s behalf.

The decision is usually recorded on a specific ‘CPR decision form’, so that it can be recognised quickly and its content assessed very quickly by those who may need it to guide their decisions and actions in an emergency situation. Increasingly such forms are designed and used to allow recording of a decision that attempted CPR is still appropriate as well as a DNACPR decision, and to allow recording of decisions about other life-sustaining treatments that may or may not be wanted by or effective for the person.

A DNACPR decision is a decision made in advance that attempted CPR would not be likely to be appropriate for a person in the event of cardiac arrest. Both patients and health professionals find conversations about DNACPR decisions especially difficult because they tend to focus only on withholding treatment that people perceive as potentially life-saving. 

In recognition of this we now recommend that, when there is some chance that CPR may bring someone back from cardiac arrest to a length and quality of life that they would want, they should be offered:

  • the chance to be given clear and accurate information about their condition and the likely risks and benefits from CPR if they should suffer cardiac arrest
  • the chance to express their beliefs and wishes and to make a shared decision with their health professionals on whether or not they should receive attempted CPR if they should suffer cardiac arrest.

The resulting ‘CPR decision’ would then be recorded either as a decision that attempted CPR would still be appropriate if they should suffer cardiac arrest or as a DNACPR decision.

When a person is dying from an advanced and irreversible condition, where CPR will not work and could cause harm, health professionals have to explain this, and the reason for needing to make and record a DNACPR decision, to patients and those important to patients in a sensitive but clear way. Such decisions are made to try to ensure that people receive the care that they need as they are dying, and that they are not subjected to violent physical treatment that will deprive them and those important to them of a dignified death.

However, for many people there is some possibility that CPR could prolong a person’s life, some possibility that it may fail, and some possibility that it may cause harm. The likelihood of each of these possibilities will vary according to each person’s situation at the time. Each person will have their own view of whether they would or would not wish to have attempted CPR in their individual circumstances. The aim will be to help each person reach a shared decision with their health professionals on whether or not they should receive attempted CPR if their heart or breathing stop. The form that records the decision can be used to record an agreed decision that CPR would be appropriate, or an agreed DNACPR decision.

In the past we used the term ‘DNR’ (Do not resuscitate). That gave a false impression that all those who received CPR would be resuscitated (i.e. would recover). We therefore changed to using ‘DNAR’ (Do not attempt resuscitation). 

However health professionals use the word ‘resuscitation’ when referring to other forms of treatment, for example ‘fluid resuscitation’ when treating a person who is severely dehydrated. Because a ‘DNAR decision’ is only about CPR and not about withholding any other treatment that a person may need or benefit from, we changed to using ‘DNACPR’ to make it clear that the decision referred only to CPR.

In the past also we sometimes used the terms ‘DNR order’ or ‘DNAR order’. However the decisions about CPR and the forms on which they are recorded are intended for the guidance of those who have to make an immediate decision in a crisis about whether or not to start a CPR attempt. They are not binding instructions and therefore are not ‘orders’. Professionals faced with making the best possible decision for a person at the time of a cardiorespiratory arrest will respect a DNACPR decision if the circumstances are those that were envisaged at the time the decision was made, but may (and must have the freedom to) attempt CPR if they believe that the emergency they are dealing with is not what was envisaged when the decision was made and recorded.For example, a DNACPR decision, made to try to ensure a dignified death for a person with an advanced and irreversible condition, would not prevent attempted CPR if that person suddenly stopped breathing after choking on some food.

CPR will restart the heart and breathing for only a (relatively small) proportion of people who suffer cardiac arrest. For those who have the potential to survive with CPR, their chances of survival get less and less with any delay in starting CPR. Therefore healthcare professionals and first-aiders know that they must start CPR without delay to have the best chance of success. They will start CPR unless they have immediately available, clear information to show them that CPR is not appropriate.

A DNACPR decision is made and recorded to guide the decisions and actions of those present should the person suffer cardiac arrest, but is not a legally binding document. 

An ADRT (as defined in the Mental Capacity Act 2005 – England & Wales) is a legally binding document that the person has drawn up (when they had capacity to make decisions) and in which they have stipulated certain treatments that they would not wish to receive, and the circumstances in which those decisions would apply. Where a properly drawn-up ADRT refuses CPR (despite acknowledging that their life would be at risk) a healthcare professional who attempts CPR on that person in full knowledge of the valid ADRT would be at risk of a charge of battery.

It is important to discuss your decision with the healthcare professionals who are involved in your care, so that they can support you in making and recording the decision that is right for you. 

If you want to record this in a legally binding document you should plan to make an ADRT, but it is often best to have it recorded on a CPR decision form as well, so that healthcare professionals will recognise it easily. Alternatively, you could simply ask your healthcare professionals to record your decision on a CPR decision form.

That form must be immediately available if it is needed in an emergency. Keeping it in a prominent place in your home is important, but remember to take it with you when you go out for any reason. If you were to collapse whilst you are out, passers-by or ambulance clinicians would be unaware of a form in a pocket or handbag, so it is important that people who are with you know about your recorded wishes and where to find the form in an emergency.

You could wear a bracelet or a neck pendant drawing attention to your decision and to the decision form or ADRT, but these would not be a good substitute for either. Healthcare professionals would need to be able to see these documents in order to be confident of taking the correct action. If someone collapses suddenly, the priority will usually be to focus on trying to treat them, so a bracelet or pendant may not be noticed. Some people have gone to the more extreme measure of having their wishes tattooed on their chest, but even that is not a substitute for a current, valid CPR decision document or ADRT. 

No, you don’t have to if you don’t want to.

However, if you want to be sure that your wishes are respected it is important that people close to you know what those wishes are and where they have been recorded (see above).

No. Not if you are an adult (the legal position is different and more complex for children and younger people and for those with parental responsibility). Your family may feel differently about your decision or may not understand fully what CPR is or why you have decided that you would not want it, but the decision is entirely yours. It is usually best to discuss your decision and the reasons for it with your family, to avoid any misunderstandings or disagreements.  

If the person concerned has capacity and does not want you to know about the details of their medical conditions and care or about decisions that they have made, you are not entitled to be given that information against their wishes.

If the person has lost capacity and the healthcare team has made a DNACPR decision for them, because CPR would not work or would not be in their best interests, the family should be consulted (unless before losing capacity the person stated that this should not happen). In other words, as a family member, you should be made aware of their condition, their chances of survival and plans for their treatment, including decisions about CPR. You may be able to help the healthcare team to make the best decision for the person, by explaining what you know about their beliefs and likely wishes. However, unless you have been given specific legal power (e.g. Power of Attorney) to make decisions about this type of treatment for them you are not entitled to make such decisions and should not be asked to do so.

A decision about CPR is only about CPR and should not affect the quality of care and treatment that you receive. Making decisions about other care or treatments (that you may or may not want to receive if appropriate) alongside the decision about CPR can help to reinforce that.

We recommend that a decision about CPR is reviewed whenever a person moves from one setting to another, so moving to a care home will provide you and your healthcare team with an opportunity to make sure that the decision is still the right one for you in your new home. The recorded decision should travel with you so that it can be respected should an emergency happen during the journey or soon after your arrival.  

Not necessarily.

Healthcare professionals could reasonably be expected to know how to recognise whether or not an ADRT or CPR decision form is valid, so would be expected to respond appropriately to the presence of such a document. 

There are also some people who are not healthcare professionals but for whom taking such documents into account should be part of their training and expected response, for example care workers and non-paramedic drivers of vehicles used to transport patients.

Others, for example some first-aiders, may have enough knowledge and training  to allow them to take these documents into account when responding to an emergency situation, whereas others may not be confident to do that and may feel that they have to attempt CPR.

The British Medical Association, Resuscitation Council (UK) and Royal College of Nursing have published detailed national guidance on decisions about CPR. Whilst this is written mainly to guide healthcare professionals, some members of the public have found it helpful when they were seeking answers to specific questions. It is available in the DNACPR section of the website.

In addition, for people with implanted cardiac devices such as (implantable cardioverter-defibrillators or pacemakers) the Resuscitation Council (UK), British Cardiovascular Society and National Council for Palliative Care have published detailed guidance for professionals, and (in collaboration also with the British Heart Foundation and Arrhythmia Alliance) an information leaflet for patients and their carers. Both are available in the defibrillators section of the website. 

Further information on decision-making towards the end of life and on ADRTs is available at:

For more information see the Do Not Attempt CPR section.

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