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DNACPR
Do not attempt cardiopulmonary resuscitation, formerly DNR
A DNACPR decision records in advance that CPR will not be attempted if a person's heart or breathing stops.
Summary
- It stands for do not attempt cardiopulmonary resuscitation, and was formerly called DNR.
- It covers CPR only. Every other treatment and all other care continue.
- A senior clinician makes the decision. The patient should be involved unless that would be likely to cause them harm.
- During the pandemic the Care Quality Commission found DNACPR decisions had been applied to groups of people without individual assessment.
In practice
- In the Tracey case of 2014, the Court of Appeal said a DNACPR decision can deprive a patient of life saving treatment, so there should be a presumption in favour of involving the patient.
- The court held that the hospital trust breached Mrs Tracey's human rights by failing to involve her in the process that led to the first DNACPR notice.
In Hong Kong
- DNACPR orders are covered by the Advance Decision on Life Sustaining Treatment Ordinance, which came into effect on 31 July 2026.
- An order based on a patient's advance directive must be issued by two registered doctors, at least one of them a specialist. Rescuers outside hospital must follow a valid order and not perform CPR.
- For children and for adults who lack capacity, doctors decide whether to issue an order by assessing the patient's best interests.
- The ordinance protects healthcare professionals and rescuers from legal liability when they honestly and reasonably believe a valid order applies.
Interview questions
- What is a DNACPR decision, and who makes it?
- A family insists that everything be done for a frail relative whose doctors think CPR would not work. What do you say?
- Why is it wrong to apply a DNACPR decision to a whole care home?
Sources
- The National Archives, case lawcaselaw.nationalarchives.gov.uk/…/822
- Hong Kong Governmentinfo.gov.hk/…/P2026073100286p.htm
- Health Bureau, Hong Konghealthbureau.gov.hk/…/index.html
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