Can you resuscitate someone with a DNR or DNACPR?

A DNR order is a medical instruction to healthcare providers not to perform cardiopulmonary resuscitation (CPR) or other life-sustaining interventions if a patient’s heart stops beating or they stop breathing.

It’s a medical decision made by the patient, their family, or healthcare professionals not to perform CPR if the patient’s heart stops or they stop breathing.

This means no efforts will be made to restart the heart or lungs in such cases.

Term slightly different used in the UK is DNACPR. DNACPR stands for Do Not Attempt Cardiopulmonary Resuscitation.

You will see that this is clearer in terms of what should not be done.

Straight forward- “DO NOT ATTEMPT CPR“. We underlined ATTEMPT.

Attempt means to try or make an effort to do something.

And it is only CPR.

Aside from CPR, resuscitation can also include using a defibrillator and managing the airway.

Both DNR and DNACPR are legal documents made with input from the patient, their family, and healthcare providers.

They ensure that a person’s wishes about end-of-life care are respected.

Healthcare professionals are usually required to follow a valid DNR (or DNACPR) order. Ignoring it could go against the patient’s wishes and may be illegal.

Key points to remember:

• The DNR order must be valid and up to date.
• Family members cannot override a DNR order, but if there’s doubt about the patient’s wishes, treatment might be given.
• A DNR order only applies to CPR, not other medical treatments.
• Some areas may have exceptions in rare cases.
• If the person with a DNR has a reversible condition, treatment might still be given.

Laws can vary, so it’s best to speak with healthcare providers or legal experts for advice on specific situations.

We will continue to use DNR in this explanation because they are closely the same thing. However, we will also mention the difference in both.

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What happens when you resuscitate a DNR?

When someone with a valid DNR (Do Not Resuscitate) order is resuscitated, many problems can come up:

Legal problems:

Doctors or nurses who ignore a DNR order could get into legal trouble. They might be sued for not respecting the patient’s rights.

Ethical problems:

It goes against the patient’s choice about their own care. It can upset family members who knew about the patient’s wishes.

Medical problems:

The patient might survive but with worse health or more suffering. They might have problems from the resuscitation process.

Job problems for healthcare workers:

Doctors or nurses could face punishment from their employers or professional bodies.

Emotional effects:

Family members and healthcare workers might feel guilty or conflicted.

Trust issues:

It can make people lose trust in the healthcare system and the idea of advance directives.

Life support issues:

The patient might end up on life support against their wishes.

Money problems:

There could be extra healthcare costs that the patient or family didn’t expect.

Sometimes, resuscitation happens because the DNR order wasn’t known at the time. When it is discovered, efforts usually stop. This is a complicated issue, and what happens can depend on local laws and healthcare rules. If this happens, it’s important to talk to medical experts or legal advisors for help.

What does a DNR (or DNACPR) form or note contain?

A DNR (Do Not Resuscitate) form usually includes several important parts to make sure it’s clear, legal, and easily understood by healthcare providers.

Here are the key elements:

Patient Information:

• Full name
• Date of birth
• Address
• Medical record number (if applicable)

Clear DNR Statement:

• A clear statement that the patient does not want CPR or other resuscitation efforts

Specific Interventions Refused:

• Details on what is refused, such as chest compressions, intubation, or defibrillation

Patient’s Signature:

• The patient’s signature (or their legal representative’s if the patient cannot sign)
• Date of signing

Physician Information and Signature:

• Doctor’s name, signature, and contact information
• Date of signing

Witness Signatures:

• One or two witnesses may need to sign
• Sometimes, a notary public signature is also required

Expiration or Review Date:

• Some forms have an expiration or review date

Medical Conditions:

• May include details about the patient’s medical conditions

Emergency Contact Information:

• Name and contact details for the patient’s next of kin or healthcare proxy

Revocation Statement:

• Information on how the patient can cancel the DNR if they change their mind

Portability Statement:

• Indicates that the DNR is valid in different healthcare settings

Instructions for Healthcare Providers:

• Clear instructions on how to act when seeing this form

The exact details can vary depending on where you are, so it’s important to use forms that follow local laws and to get advice from healthcare providers or legal experts when making or understanding a DNR order.

Example of the electronic DNACPR Form from NHS is shown below [ PDF Credit to NHS England]. You can download on their website via the link above.

This is what a DNACPR looks like:

As mentioned earlier, the DNR or DNACPR form content will depend on location and what is required.

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Key Differences Between DNR and DNACPR

DNR (Do Not Resuscitate) and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) are very similar but not exactly the same.

Here’s the difference:

DNR (Do Not Resuscitate):

• This term is mostly used in the United States.
• It means no CPR (cardiopulmonary resuscitation) if the patient’s heart stops or they stop breathing.
• Sometimes, it may be unclear what other treatments are included unless more details are given.

DNACPR (Do Not Attempt Cardiopulmonary Resuscitation):

• This term is more common in the UK and other countries.
• It specifically says no CPR should be attempted.
• The word “Attempt” is used because CPR does not always work.

Key differences:

• Specificity: DNACPR is clearer that only CPR is refused.
• Clarity: DNACPR leaves less room for confusion about which treatments are refused.
• Other treatments: Both DNR and DNACPR usually refer only to CPR, but DNACPR makes this clearer.
• Regional usage: DNR is common in the US, while DNACPR is used more in the UK.
• Language: DNACPR recognises that CPR is an attempt that might not succeed.

Even though the terms are different, they both mean the patient does not want CPR if their heart or breathing stops.

A DNACPR order includes a DNR order, but a DNR order doesn’t always mean DNACPR. This also depends on meaning from one country to another.

DNACPR is generally more clear and specific. It’s important that the document explains exactly what is and isn’t covered and that it’s discussed with doctors so everyone understands the patient’s wishes.

Legality of DNACPR

In the UK, DNACPR are legally binding if it has been properly completed and communicated. However, it’s not a legal document in the same way as a will or power of attorney.

DNACPR decisions fall under the Mental Capacity Act 2005. Healthcare workers should follow them if they are correctly made and communicated. Get up-to-date training on mental capacity act 2005 as a healthcare worker.

For the most accurate and current information in your area, it’s best to speak with a local healthcare provider, legal expert, or healthcare authority.

Note: Alway consider the information from the local authority above what was written on this page. You can read more from NHS website or any government website.