Do Not Attempt Cardiopulmonary Resuscitation Dnacpr Decisions

Overview

A DNACPR decision stands for 'Do Not Attempt Cardiopulmonary Resuscitation'. It is a written plan that says if your heart stops beating or you stop breathing, no one should try to restart it using CPR. CPR (cardiopulmonary resuscitation) is the emergency treatment where a person presses hard on your chest, gives electric shocks, or helps you breathe with a machine. A DNACPR decision is only about CPR. It does not mean that other treatment, care, pain relief, or kindness stops. It is not the same as 'do not treat'. You may also hear it called DNAR, 'do not resuscitate', or a 'No CPR' plan.

Yes, it is common. DNACPR decisions are made every day in hospitals, care homes, and GP surgeries, usually for people who are very frail or living with a serious illness that cannot be cured. Many people also choose to record their wishes in advance, before any decision is needed.

Anyone can be offered a conversation about CPR, but DNACPR decisions are most often discussed with older adults who are frail, people with advanced illness such as cancer, heart failure, or dementia, and people whose death is expected in the near future. It can also apply to younger people who are very seriously ill. A DNACPR decision for a child is rare and is always made jointly with parents or carers.

Symptoms

Common symptoms

• A DNACPR decision is not an illness, so it has no symptoms of its own.
• Instead, you may notice signs that a doctor or nurse wants to talk about CPR: a conversation about your health getting worse, about what matters most to you, or about your wishes for the future.
• You may be given a form to sign, or asked who you would like to be involved in the discussion.
• Feeling anxious, upset, or relieved when the topic comes up is normal.

Symptoms in children

• In children, CPR discussions usually happen only when a child has a life-limiting or very serious condition.
• Parents and carers are always fully involved, and the child's own views are included where they are old enough to understand.
• The focus is on keeping the child comfortable and giving the best possible care, not on withdrawing treatment.

Symptoms in older adults

• Older adults are more likely to be asked about CPR, especially after a hospital stay, a fall, or if they live with frailty or several long-term conditions.
• A review of medicines, care needs, or a move into a care home often triggers a conversation about future planning.
• Memory problems do not automatically mean someone cannot be involved — they should still be supported to take part as far as they can.

Causes

Main causes

• Frailty and very poor general health, where the body is unlikely to recover even if CPR restarts the heart.
• Advanced illness that cannot be cured, where CPR would not change the outcome and could cause suffering.
• The person's own clearly expressed wish not to have CPR, recorded in advance.
• A medical team's judgment, made in someone's best interests when they cannot decide for themselves, after talking with people close to them.
• A dying phase of illness, where the priority is comfort and a peaceful death.

Risk factors

• Being in the last months or weeks of life with a serious illness.
• Living with dementia or severe frailty, especially after repeated hospital admissions.
• Having several long-term conditions at once.
• Being in a care home or hospital for a long stay.
• Having already written an advance care plan or advance decision saying you do not want CPR.

When to see a doctor

See a doctor urgently if:

• You want a DNACPR decision reviewed quickly because your health or wishes have changed.
• You feel confused, pressured, or distressed about a decision and need to talk it through.
• A family member is very upset about the plan and needs support or an explanation.
• You cannot find the form or it is not being passed between services.

Book a routine appointment if:

• You would like to talk about CPR and future care planning, even if you are well.
• You want to write down your wishes in advance, or update an existing plan.
• You are caring for someone and want to understand what a DNACPR decision does and does not mean.
• You want the decision reviewed at a planned appointment because your health has improved.

Diagnosis

There is no test for a DNACPR decision. Instead, it is made through a conversation. A doctor or nurse will explain what CPR involves, how likely it is to work for you, and what it might mean for your comfort and recovery. They will ask about your wishes and what matters to you. If you are able to make the decision, your view is central. If you cannot, the team will decide in your best interests and involve the people closest to you. The decision is written on a form and shared with the services that care for you.

Tests that may be done

• No laboratory or imaging test is used; the decision is based on your overall health and your wishes.
• Sometimes the team will assess whether you can understand and weigh up the information, called a mental capacity assessment.
• They may review recent medical notes, test results, and any advance care plan you have already made.
• They may ask about what you already know about your health and what you would want if you became more unwell.

What to expect at your appointment

You can expect a calm, honest conversation, often with a relative or friend present if you want. You do not have to decide on the spot. You can ask for a second opinion, ask for more time, or ask for the decision to be delayed until you have spoken with your family. Whatever is agreed is written down clearly, kept in a safe and findable place, and reviewed regularly or whenever your health changes.

Treatment

A DNACPR decision is not a treatment, and it does not reduce your care. It sits alongside a wider care plan that sets out what should happen if you become more unwell — for example, whether you would want to go to hospital, receive fluids, or have treatment for an infection. All treatments that can help you feel better or recover are still available.

Self-care at home

• Talk with the people closest to you about your wishes, so they are not guessing in a crisis.
• Ask where the form is kept and make sure it travels with you, for example to hospital or a new care setting.
• Keep a copy or note of who to contact if the plan needs to be reviewed.
• Write down your questions before appointments, and bring someone with you if that helps.
• Ask your GP or care team about making a wider advance care plan, covering things like where you would prefer to be cared for.

Medical treatments

Care continues in every way that can help. Teams may offer treatment for infections, medicines to ease pain, breathlessness, nausea, or anxiety, fluids, oxygen, physiotherapy, and admission to hospital if that is what you want and it can help. Many people also receive palliative care, which is specialist support focused on comfort, symptoms, and quality of life for you and your family. Your medical team will explain the options in plain words and check what you want before any treatment decisions are made.

When is surgery considered?

If you need an operation, the team will talk with you about whether the DNACPR plan should be paused for the period around surgery and the anaesthetic, because the situation is different from your usual health. This is a temporary change, agreed with you, and the original plan can be restored afterwards.

Living with this condition

Most of daily life carries on exactly as before. A DNACPR decision is a piece of planning, not a change to your routine. What may change is a sense of relief for some people, knowing that their wishes are known and written down, and that their family will not have to guess.

Lifestyle tips

• Keep doing the things that give your life meaning, at a pace that suits you.
• Make sure any care staff, care home, or hospital knows about the plan when you move between services.
• Review the plan at least once a year, or sooner if your health changes for better or worse.
• Talk openly with family so they understand what the plan does and does not cover.
• Ask about practical support such as home care, equipment, or help with appointments.

Diet and exercise

There is nothing special to avoid. Eating and drinking well and staying as active as your health allows can help you feel better and keep your strength. If swallowing is difficult, or you have lost weight without trying, ask your team for advice from a dietitian or speech therapist. Gentle movement, such as short walks or chair-based exercises, is often helpful, but check with your doctor or physiotherapist first if you are not sure what is safe.

Mental health and emotional wellbeing

It is very normal to feel a mix of emotions — fear, sadness, relief, anger, or worry about burdening others. Some people find the conversation brings them closer to their family; others find it distressing and want to revisit it later. Feeling low or anxious for more than a couple of weeks, or having thoughts of not wanting to go on, is a reason to reach out for help. If you ever feel unable to keep yourself safe, contact your local emergency number or a crisis line in your country straight away, and tell someone you trust.

Prevention

This is not an illness that can be prevented, and there is nothing you did to cause it. What you can do is plan ahead. Making your wishes known early — through a conversation with your GP and, if you wish, a written advance care plan — means that decisions later reflect what matters to you, rather than being made in a hurry during a crisis.

Screening programmes

There is no screening test. Some GP surgeries and hospitals routinely offer a conversation about future care planning to people with serious long-term conditions or frailty, and you can ask for one at any time.

Complications

If left untreated

• If CPR wishes are never discussed, someone may receive CPR they would not have wanted, sometimes with a distressing death in hospital.
• Family members may be left to make difficult guesses in an emergency, which can cause lasting guilt or distress.
• Ambulance and hospital teams may be unsure what to do, leading to delays or unwanted transfers to hospital.
• People sometimes wrongly believe a DNACPR decision means all treatment stops, which can cause fear and mistrust — clear explanations help prevent this.

Long-term outlook

Having a plan in place often brings real peace of mind. It means your care can focus on comfort, dignity, and the things that matter most to you, and the people close to you have clear guidance if the worst happens. Plans can be reviewed and changed whenever you want, and there is no deadline for talking things through. Whatever you decide, you deserve kindness, honest information, and support along the way.

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