What does DNACPR actually mean?
DNACPR stands for 'do not attempt cardiopulmonary resuscitation'. It is a decision, made in advance, that CPR will not be attempted if the person's heart and breathing stop. It covers one treatment only.
CPR can save lives, especially in a sudden arrest from a shockable rhythm in someone otherwise well. It is also forceful and invasive. Ribs often break, survivors often need intensive care, and some have brain injury. For someone dying of an advanced illness, or who is very frail, CPR is unlikely to restore a sustained circulation and may mean their final moments are spent undergoing a traumatic procedure instead of dying peacefully.
What is the ReSPECT form?
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It was developed by a working group led by Resuscitation Council UK and is a process, not just a form. Through a conversation, the person and their clinicians record recommendations for care in a future emergency when the person cannot make or express choices.
Instead of a single yes or no about CPR, ReSPECT asks what matters to the person and which treatments would or would not be wanted or helpful, such as hospital admission, intensive care or ventilation. The CPR recommendation sits inside that wider plan. The person keeps the plan and it travels with them between home, care home, ambulance and hospital.
| DNACPR form | ReSPECT plan | |
|---|---|---|
| Scope | CPR only | Emergency care and treatment, including a CPR recommendation |
| Focus | Whether to attempt CPR | What matters to the person and what treatments are appropriate |
| Who holds it | Usually the clinical record | The person, plus copies in records |
| Legal status | Clinical decision, not legally binding on the patient | Recommendations, not legally binding |
| Where used | Throughout the UK; Wales has an All Wales DNACPR policy | Most of England, many Scottish boards, being adopted in Northern Ireland; not used in Wales |
Which form you use depends on where you work. Check whether your area uses ReSPECT, a local treatment escalation plan, or a stand-alone DNACPR form.
Is a DNACPR or ReSPECT form legally binding?
Neither is legally binding in itself. Resuscitation Council UK is clear that signatures on a ReSPECT plan do not make its recommendations binding. In an emergency, clinicians use the form to guide decisions but must still judge the situation in front of them. A person with a 'not for CPR' recommendation who chokes on food should still have the airway cleared.
The exception is a valid and applicable advance decision to refuse treatment (ADRT). In England and Wales, an ADRT refusing CPR is legally binding if it is in writing, signed and witnessed, and states that it applies even if life is at risk. A ReSPECT plan can record that an ADRT exists, but the ADRT is the binding document.
Who makes the decision, and do you have to tell the patient?
The main UK guidance is the joint BMA, Resuscitation Council UK and RCN guidance, Decisions relating to cardiopulmonary resuscitation, alongside the GMC's guidance on treatment and care towards the end of life. Overall responsibility usually rests with the most senior clinician responsible for the person's care, such as the consultant or GP. In some organisations trained senior nurses and other professionals can make these decisions. Junior doctors may document a decision but local policy usually requires senior confirmation within a set time.
The duty to consult
In England and Wales, the Court of Appeal in Tracey (2014) set a presumption in favour of involving a patient with capacity in a DNACPR decision. You should only avoid discussing it if you have good reason to think the conversation would cause physical or psychological harm. Finding it awkward or upsetting is not enough. In Winspear (2015) the High Court held that when the patient lacks capacity, those close to them should be consulted where practicable and appropriate before the decision.
| Situation | What the guidance says |
|---|---|
| CPR could realistically work and the person has capacity | The person decides after an informed discussion. A valid refusal must be respected. |
| CPR could realistically work but the person lacks capacity | A best interests decision, considering their wishes and values and consulting those close to them. A valid ADRT or a relevant attorney must be respected. |
| CPR would not work | CPR is not offered. The person, or those close to them, should still be told and given reasons unless this would cause harm. They cannot demand CPR but can ask for a second opinion. |
Families cannot consent to or refuse treatment on someone's behalf unless they hold a lasting power of attorney for health and welfare covering life-sustaining treatment, or are a court-appointed deputy with that authority. Scotland and Northern Ireland have their own capacity laws.
How to have a ReSPECT or DNACPR conversation
These conversations are easier if you start with the person's understanding and priorities rather than with CPR itself.
- Prepare: Know the diagnosis, the likely outcome of CPR and other treatments, and any advance care plans. Decide whether you are offering CPR as an option or explaining it would not work. Find a private space and an interpreter if needed.
- Explore understanding: Ask what the person knows about their health and what they think might happen.
- Explore what matters: Ask about priorities, hopes and fears if they become more unwell. Being at home, being comfortable or having every chance of longer life are all valid.
- Share information honestly: Explain what is likely to happen, which treatments may help, what CPR involves and how likely it is to work for them.
- Make recommendations together: Agree recommendations that match their priorities and what is clinically realistic. If CPR is a real option, the person with capacity decides. If not, explain the decision and the reasons.
- Check, record and share: Summarise, check understanding, complete the form and notes, and make sure the decision is handed over.
Mr P, if your heart stops do you want us to do CPR? Most people your age don't survive. Shall I put you down as not for resus?
Mr P, I'd like to talk about how we look after you if you become more unwell, so we can plan around what matters to you. You've said being at home with your wife matters most and you wouldn't want to be kept alive on machines. Your lung disease is now very advanced. If your heart stopped, we don't think trying to restart it would work, so we'd recommend not attempting it and focusing on your comfort. We would still treat infections and breathlessness. How does that sound?
The weak version asks him to choose a treatment that would not work, uses age as the reason and implies care stops. The strong version starts from his priorities, explains the recommendation honestly and makes clear that treatment continues. When CPR would not work, you are informing, not asking.
How should the decision be recorded?
- Use the correct local or regional form.
- Record full name, date of birth and NHS number (or equivalent) on every page.
- State the clinical reason in clear words, for example 'advanced metastatic lung cancer with progressive decline; CPR would not be successful'.
- Record whether the person has capacity for this decision and, if not, how this was assessed and who was consulted.
- Record who it was discussed with, when, and their response. If it was not discussed, record the specific reason.
- Sign, print name, role and registration number, and date and time it, following local rules on senior confirmation.
- Hand it over and record it in the electronic record.
Case study: a DNACPR form that failed
A DNACPR form completed in the emergency department said only 'frailty, age'. It had no senior signature and recorded 'not discussed: patient confused'. No relative had been contacted. Overnight her oxygen levels fell and a newly qualified nurse hesitated to escalate because she thought the form meant 'not for treatment'. The next morning her daughter was distressed to find a form existed. On review Mrs L had fluctuating delirium and, on a better day, could discuss her care. The foundation doctor, Kwame, and the consultant spoke with her and her daughter and completed a ReSPECT plan recording her wish to be treated for infection in hospital but not to have CPR or intensive care. Kwame reported the original form as an incident so the learning could be shared.
Each problem was avoidable: a reason based on age, no proper capacity assessment, no consultation, no senior confirmation and confusion between DNACPR and a ceiling of treatment.
What if the patient or family disagrees?
Disagreement usually comes from fear, missing information or not feeling heard. Listen first, explain your reasoning again in plain language and make clear that other treatment continues. If disagreement remains, offer a second opinion from another senior clinician, as both the joint guidance and the GMC support. For serious unresolved disputes, seek advice from your organisation's legal team. Never make a decision in secret or alter a record to avoid a hard conversation.
Review decisions when the person's condition changes, when they move between settings, and when they or those close to them ask. A DNACPR decision does not automatically continue during anaesthesia or procedures and should be discussed beforehand. If a person with an implantable defibrillator is not for CPR, discuss deactivation.
Learning more
This guide is educational and is not legal advice; follow the joint CPR guidance, your regulator's standards and local policy. The DNACPR Decisions and ReSPECT Conversations course works through the law, conversations and record keeping with case studies and a reflective exercise for your CPD record. For patients who are for CPR, keep your skills current through accredited hands-on resuscitation training.
Frequently asked questions
Can a family member overrule a DNACPR decision?
Families cannot demand CPR that clinicians judge would not work, and they cannot consent or refuse on the patient's behalf unless they hold a relevant lasting power of attorney or are a court-appointed deputy. They should be consulted when the patient lacks capacity, listened to, and offered a second opinion if they disagree.
Does a DNACPR mean no treatment at all?
No. A DNACPR decision applies only to cardiopulmonary resuscitation. The person should still receive all other appropriate care, which may include antibiotics, fluids, oxygen, hospital admission, intensive care and symptom control. Any other limits on treatment need their own individual decisions, which a ReSPECT plan can record.
Do doctors have to tell the patient about a DNACPR decision?
In England and Wales, case law sets a presumption that a patient with capacity should be involved, even when CPR would not work. You can only avoid the discussion if it would cause physical or psychological harm, not simply distress. When the patient lacks capacity, those close to them should be consulted where practicable.
Who can sign a DNACPR or ReSPECT form?
The most senior clinician responsible, such as the consultant or GP, usually holds responsibility. Some organisations allow trained senior nurses and other professionals to make these decisions. Junior doctors may complete forms in some settings but local policy usually requires senior confirmation within a set time. Check your organisation's policy.
Is a ReSPECT form valid if the person moves to a different hospital or care home?
Yes, the plan is designed to travel with the person across settings, and earlier versions remain usable in an emergency. It should be reviewed at the next clinical contact, when the person's condition changes and when they move between settings. Clinicians must still judge whether it fits the situation they face.
Is a DNACPR decision based on age or disability lawful?
A decision based on age, frailty or a disability alone is unacceptable and may be unlawful discrimination. National reviews have criticised blanket decisions. The reason recorded must explain why CPR would not succeed for that individual, or why the person or their best interests would not support it.
What is the difference between ReSPECT and an advance decision?
A ReSPECT plan records clinical recommendations agreed through a conversation and is not legally binding. An advance decision to refuse treatment is made by the person while they have capacity and, if valid and applicable, is legally binding in England and Wales. A refusal of CPR in an ADRT must be written, signed, witnessed and state it applies even if life is at risk.
Related courses
DNACPR Decisions and ReSPECT Conversations
This course explains how decisions about cardiopulmonary resuscitation are made, discussed and recorded in the UK, and how the ReSPECT process places…
Adult Advanced Life Support (UK Guidelines)
This course explains the recognition and management of adult in-hospital cardiac arrest, based on the current Resuscitation Council UK adult advanced…
Paediatric Life Support (UK Guidelines)
This course teaches the recognition of the seriously ill or injured child and the management of paediatric cardiorespiratory arrest, based on current…
Sources and further reading
- Decisions relating to cardiopulmonary resuscitation. British Medical Association, Resuscitation Council UK and Royal College of Nursing.
- ReSPECT: Recommended Summary Plan for Emergency Care and Treatment. Resuscitation Council UK.
- ReSPECT policy briefing (updated February 2026). Resuscitation Council UK.
- Treatment and care towards the end of life: good practice in decision making. General Medical Council.
- Mental Capacity Act 2005 Code of Practice. Ministry of Justice.
- Protect, respect, connect: decisions about living and dying well during COVID-19. Care Quality Commission.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
The Mental Capacity Act 2005 Five Principles and Valid Consent Explained
The Mental Capacity Act 2005 five principles explained with examples, plus the capacity test, best interests and what makes consent valid after Montgomery.
What Happens If You Breach Patient Confidentiality? A Guide for Healthcare Staff
What happens if you breach patient confidentiality: disciplinary action, regulator referral, possible prosecution, what to do straight away and how to reflect.
Chaperones and Intimate Examinations: GMC and NMC Guidance Explained
Chaperone and intimate examination guidance explained: GMC and NMC expectations, NHS England principles, consent, who can chaperone and what to record.