Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Make individual, evidence-based decisions about cardiopulmonary resuscitation and other escalation, involve the patient or lawful representative, document reasoning and review triggers, and prevent a CPR recommendation from restricting beneficial ordinary treatment.
CPR is a specific emergency treatment for cardiorespiratory arrest. Its physiological success and the chance of leaving hospital with an outcome acceptable to the patient vary greatly with cause, comorbidity, frailty, setting and pre-arrest function. A DNACPR recommendation records that CPR should not be attempted; it says nothing by itself about antibiotics, fluids, oxygen, analgesia, imaging, surgery, dialysis, non-invasive ventilation or transfer.
Decision making begins with clinical evidence. Determine whether arrest is likely, whether causes could be reversible, what CPR would involve and what outcome is realistically achievable. Explain the distinction between restarting the heart briefly and meaningful recovery. Population figures can support discussion but never replace individual reasoning. Disability or dependence should not be treated as evidence that a person's life has lower value.
Involvement follows capacity and decision authority. A capable adult can refuse CPR. If the team concludes CPR cannot offer benefit, the patient is informed and their views considered, but they cannot require clinicians to deliver a clinically inappropriate intervention. When capacity is absent, check advance decisions and authorised welfare proxies, involve the person as far as possible and consult those close to them for values rather than asking them to consent by family status alone.
Progressive organ failure, advanced malignancy, severe frailty or acute deterioration should prompt proactive CPR and escalation review before an emergency.
Anaphylaxis, choking, procedure complication, acute arrhythmia or drug effect may alter the chance that CPR achieves a meaningful recovery.
Irreversible multisystem decline or terminal dying may make restoration of sustained circulation physiologically impossible or unable to provide overall benefit.
Ward antibiotics, fluids, non-invasive ventilation, surgery, dialysis and intensive care each require separate benefit-burden and preference decisions.
Staff withholding observations, analgesia or reversible-cause treatment because of a CPR form signals an urgent safety and education problem.
Disputed facts, proxy authority, religious belief or family demand for treatment requires clarification, senior leadership and a transparent review route.
Before arrest, the patient remains entitled to assessment and each clinically appropriate treatment within their agreed broader plan.
A small chance of success is not identical to physiological impossibility; likely outcome, burden and the patient's values complete the judgment.
Clinical benefit concerns achievable outcomes and treatment burdens for this person, not a judgment about the social worth of disability.
The process summarises personalised emergency recommendations but does not replace capacity law, informed refusal or bedside clinical judgment.
Reconsidering a decision after change does not mean reversing it; the clinician may document that the reasoning and recommendation remain appropriate.
Anaesthesia or an intervention may create a reversible arrest risk, so existing CPR recommendations should be discussed rather than automatically suspended or applied unchanged.
Using DNACPR to withhold non-CPR treatment or basic care.
Making group decisions for everyone with a diagnosis, disability or residence type.
Discussing only what will be withheld and not what active care will continue.
Asking relatives to sign consent when they have no relevant legal authority.
Assuming that every request for CPR must be offered regardless of clinical effect.
Avoiding discussion because foreseeable distress is mistaken for serious harm.
Copying an old form without assessing current context or patient wishes.
Sending a patient between settings without an accessible, reconciled emergency plan.
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A care-home resident with a DNACPR recommendation develops fever and hypoxia from suspected pneumonia, and ward-level treatment accords with their documented goals. What should happen?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes
Communication should occur early enough for reflection, usually within a wider conversation about deterioration and treatments that will be offered. Explain what the team will do, not merely what it will not do. Ordinary upset is not a reason to conceal a decision. Exceptionally, if discussion is judged likely to cause serious physical or psychological harm, record the specific grounds, consult those close to the person where appropriate and revisit.
Documentation systems differ between UK nations and organisations. ReSPECT is one recognised process, not a universal legal form. The underlying duties of individual assessment, non-discrimination, communication and review remain. Transfers should include the current original or authorised electronic record; a photocopied acronym without reasoning invites harmful overinterpretation.