END OF LIFE LAW: DO NOT RESUSCITATE DECISIONS
‘Do Not Resuscitate’ (DNRs) or ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACRs) orders are medical documents advising doctors not to try and restart someone’s heart. A DNR is only put on someone’s medical file when a medic believes chest compressions would be of no use.
Mouth-to-mouth and chest compression is a vigorous emergency procedure and only works around 40% of the time. For those it does work on, it might only be partially successful – meaning someone survives but suffers serious brain damage or organ damage. As a patient, you can refuse CPR via an Advance Decision but you cannot demand someone give it to you.
HOW DO DNRs WORK?
If a medic believes that mouth-to-mouth or chest compressions would be of no use or do more harm than good, a DNR can be placed on their medical records. Medics are ultimately responsible for deciding who has a DNR and who does not. That means a medic can put a DNR on someone’s file without that person specifically requesting it. However, you can refuse chest compressions as part of an Advance Decision.
Medics cannot place a DNR on someone’s file without making them aware. Doctors are legally required to discuss their decision to place a DNR on someone’s file, explain their reasons, and listen to a patient’s potential concerns. The only time a doctor is allowed not to do this, is if they reasonably think telling the patient would cause them psychological harm.
If someone doesn’t have mental capacity, then a medic should involve that individual’s family, friends, and carers in the decision making process instead.
IMPACT ON OTHER TREATMENT
A DNR only affects CPR and chest compressions. That means unless you decide to limit them via an Advance Decision, all other medical treatments will continue as normal.
If someone wants to challenge a DNR decision, a doctor should listen to their concerns and as a matter of good practice get a second opinion or discuss the DNR with a senior staff member.