Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Urgent decisions under uncertainty
Time-critical treatment may be needed before capacity, representatives or prior wishes are fully clarified. A DNACPR decision addresses cardiopulmonary resuscitation only and must not delay other clinically appropriate emergency care.
Action: Give immediately necessary life-saving treatment unless a valid applicable refusal is known, seek rapid collateral and records, assess decision-specific capacity, use the least restrictive best-interests process when required, and review the decision as information and physiology evolve.
Synopsis
Elicit outcomes that matter, explain realistic options and uncertainty, make lawful shared or best-interests decisions, and convert values into specific treatment, escalation, symptom and contingency plans that remain open to review.
Goals are outcomes such as comfort, cognition, mobility, longevity, independence, staying home or attending an event—not merely treatment names.
First-line shared decision-making creates choice awareness, discusses reasonable options including no change, and supports preference after material benefits, harms and uncertainty.
Ask what the person understands, what matters, what burden is unacceptable and what trade-off they would accept; avoid asking only whether they want everything done.
Key red flags
Do not interpret DNACPR as no antibiotics, fluids, oxygen, surgery, ward escalation or symptom treatment; each intervention needs its own decision.
Invalid proxy assumption
A relative is asked to decide despite no verified attorney authority and no documented best-interests process.
Investigation priorities
01
Understanding and priority conversationFirst step
Define the decision and desired outcomes.
02
Carer and service feasibilityPreferred
Test whether the preferred plan can operate.
Management branches
First-line shared decisionCreate choice, compare options, reach or defer a decision
More than one reasonable care option exists.
Explain the decision and invite the person's goals, preferred involvement and chosen supporters.
Discuss reasonable options, no change, absolute benefits, harms, burden and uncertainty in accessible language.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.