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DNACPR discussions

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A DNACPR decision is about CPR only — every other appropriate treatment continues.

The senior responsible clinician makes the decision, and the patient (or those close to them) must be involved unless it would cause them physical or psychological harm.

Act now

  1. 1

    Arrest imminent and no decision in place: CPR is the default unless it clearly cannot work or there is a valid refusal — call a senior.

Assess

  • What matters to the patient; capacity for this decision; prognosis and likely outcome of CPR.
  • Existing ReSPECT form or anticipatory care plan, advance decision, welfare attorney or health and welfare LPA.

Investigations

  • Review what informs prognosis: recent results and imaging, frailty score, trajectory of illness.

Manage

  • Frame the conversation around goals and what matters most, then explain where CPR fits.
  • If CPR would not work, it is not offered as a choice — but the patient should still be told and given the chance to ask for a second opinion.
  • Record the decision and the conversation on the local DNACPR or ReSPECT form, tell the team, and review it when things change.

Escalate when

  • Disagreement with the patient or family, or uncertainty: senior, second opinion, and ethics or legal advice if needed.

Written to current guidance · sources checked 14 Nov 2026. We watch NICE for updates weekly.

Sources (2)

Reviewed by Aboodee Alhasso, MPharm MRCPharm IP on 14 Nov 2026

For healthcare professionals, as an aid to clinical judgement — not a substitute for it. Follow your local policy and ask a senior when in doubt.