FAQs: Recommendations about CPR

This page contains answers to your frequently asked questions on Recommendations about CPR.

Below, you'll find a series of questions. When you click, you will see all of the answers on this topic.

If you would like to browse our other FAQs, click here.

These questions relate to DNACPR. To view the answers, click the question or the + sign next to the question.

The purpose of a DNACPR recommendation is to provide immediate guidance to those present (mostly healthcare professionals) on the best action to take (or not take) should the person suffer a cardiac arrest or die suddenly. 

It may not be in everybody’s best interest to be resuscitated.
Not everyone wants to receive attempted CPR, so it is important to respect what is important to them and to make sure they are offered a chance to make choices that are right for them.

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.  

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.

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

For more information, read our DNACPR information.

A DNACPR recommendation is made in advance and records 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 recommendations especially difficult because they tend to focus only on withholding interventions 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 what is important to them and to make a shared recommendation with their health professionals on whether or not they should receive attempted CPR if they should suffer cardiac arrest.

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

The form that records the recommendation can be used to record an agreed recommendation that CPR would be appropriate, or an agreed DNACPR recommendation.

An Advance Decision to Refuse Treatment (ADRT) is (as defined in the Mental Capacity Act 2005 – England & Wales) a legally binding document that the person has drawn up (when they had the 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.

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

However, if you want to be sure that what's important to you is respected it is important that people close to you know what they are and where they have been recorded.

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

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

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.

In addition, for people with implanted cardiac devices (such as implantable cardioverter-defibrillators or pacemakers) 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 resources can be found here.

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

These questions relate to ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). To view the answers, click the question or the + sign next to the question.

No. The recommendation whether to perform CPR should be discussed within the broader context of their overall goals of care and treatment. It is essential to understand what is important to them and what they would or would not want in an emergency. The recommendation whether to perform CPR is only one part of this.

If a person is unable to contribute to recommendations (for example because they are unconscious, severely demented, or too severely ill to participate in the discussion), the recommendation 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.

Family members are not expected to or entitled to make recommendations around CPR unless they have been given legal power (e.g., Lasting Power of Attorney) to make such recommendations on the person’s behalf.

Yes, you can have a ReSPECT conversation and update an existing ReSPECT plan assuming you have the same version as the patient (ordinarily a patient would have a face to face meeting where a single plan could be updated). If the plan is available electronically this should not be a problem. Either a new plan will need to be written or printed electronically to reflect the changes agreed and this would need to be sent to the patient. The patient would then need to be advised to score through the “old” plan and write ‘CANCELLED’ clearly on the plan.

An ADRT is a legal document that people in England & Wales can complete to refuse treatment that they don’t want to receive. If it is completed according to the Mental Capacity Act 2005 it is legally binding.

A ReSPECT plan can be used to draw attention to the presence of an ADRT and should contain relevant aspects within the summary recommendations for treatment and care. If you would like to find out more about ADRTs, visit https://www.nhs.uk/conditions/end-of-life-care/planning-ahead/advance-decision-to-refuse-treatment.

A ReSPECT plan summarises the emergency care aspect of a wider Advance or Anticipatory Care planning process. ReSPECT records information so as to make it rapidly accessible to professionals who need to make immediate decisions about care and treatment in a crisis. An ACP or EOL plan document is usually longer and more detailed than ReSPECT. It is not restricted to planning for an emergency and is likely to contain more information.

Arrangements for the provision of ReSPECT training and resources are made at a local level. In each locality there should be a lead for ReSPECT. Please contact the ReSPECT lead in your area to find out what arrangements have been put in place. If you are unable to find out who is leading locally, then please get in touch, advising us of your locality and we will try and refer your enquiry to the correct person.