This page contains answers to your frequently asked questions on Decision Making (CPR).
Below, you'll find a series of topics relating to Decision Making. When you click the topic, you will see all of the questions and answers on this topic.
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These questions relate to DNACPR. To view the answers, click the question or the + sign next to the question.
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.
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 people’s wishes and to make sure that 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 decision 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 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 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.
The form that records the decision can be used to record an agreed decision that CPR would be appropriate, or an agreed DNACPR decision.
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 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.
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.
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.
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.
No.
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.
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:
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.
The objectives of the ReSPECT process are to promote advance care planning, good communication, shared decision making, and good documentation with cross-boundary recognition. The resuscitation status of a person is only one aspect of the overall plan of emergency care and treatment.
No. Each person is an individual whose needs and preferences must be taken account of in the context of their overall health and medical history. Blanket policies are inappropriate whether due to medical condition, disability, or age. This is particularly important in decisions around not resuscitating a person, which should only ever be made on an individual basis and in consultation with the individual or their family/Lasting Power of Attorney.
No. The resuscitation status of a person 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 resuscitation status of a person is one part of this.
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.
Family members are not expected to or entitled to make decisions around the resuscitation status of a person unless they have been given legal power (e.g. Lasting Power of Attorney) to make such decisions on the person’s behalf.
Ideally ReSPECT conversations should take place face to face. However, during extraordinary times such as COVID-19 it is reasonable to have a telephone conversation with a patient, complete and sign the ReSPECT form and then post it to the patient. The caller must at all times ensure that they, and the patient understand and agree what is being said.
Yes, you can have a ReSPECT conversation and update an existing ReSPECT form assuming you have the same version as the patient (ordinarily a patient would have a face to face meeting where a single form could be updated). If the form is available electronically this should not be a problem. Either a new form 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” form and write ‘CANCELLED’ clearly on the form.
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 form 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, or make one for free, you can do so at www.mydecisions.org.uk.
A ReSPECT form is a very specific type of ACP that summarises the emergency care aspect of a wider Advance or Anticipatory Care planning process. ReSPECT records that 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 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, either at the Trust or CCG. 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 local Trust or CCG and we will try and refer your enquiry to the correct person.
