DNACPR and advance decisions explained for families

A DNACPR (do not attempt cardiopulmonary resuscitation) decision means that if a person’s heart or breathing stops, staff will not try to restart it. It covers CPR only, and all other care and treatment continues. The final clinical decision rests with the senior doctor, but it must be discussed with the person, or with their family if they lack capacity. A legally binding refusal of treatment needs a written advance decision under the Mental Capacity Act 2005.

In short

• DNACPR is about CPR only: it does not mean “do not treat”, and people with DNACPR forms still get antibiotics, fluids, pain relief and hospital care where appropriate.
• Nobody can demand CPR, but doctors must tell the person a decision has been made and consult those close to them if the person lacks capacity.
• Blanket DNACPR decisions applied to groups, for example everyone in a care home or everyone over a certain age, are unacceptable according to the CQC and professional bodies.
• An advance decision to refuse life-sustaining treatment must be written, signed, witnessed and state that it applies “even if life is at risk” (Mental Capacity Act 2005, section 25).
• A health and welfare lasting power of attorney (LPA) costs £92 to register and only gives authority over life-sustaining treatment if the donor ticks that option.
• If you disagree with a DNACPR, ask for a second opinion, then use the NHS complaints process and, if needed, the Public Service Ombudsman (formerly the Parliamentary and Health Service Ombudsman).

What DNACPR is, and what it is not

CPR involves chest compressions, rescue breaths and sometimes electric shocks from a defibrillator. On television it often works. In real life, for frail older people with several serious illnesses, it rarely succeeds, and it can cause broken ribs and brain injury. A DNACPR decision is made when CPR would not work, or when the harm would outweigh the benefit, or when the person has said they do not want it.

Who decides about CPR

There are three ways a DNACPR decision comes about:

1. The person refuses CPR. An adult with capacity can say they do not want CPR. To make that binding for a time when they cannot speak for themselves, they need a valid advance decision.
2. The doctor decides CPR would not work. If CPR is very unlikely to restart the heart, the senior doctor can make a DNACPR decision even if the person or family disagree. Nobody has the right to demand a treatment that will not work.
3. A best-interests decision. Where CPR might work but could leave the person in a state they would not want, the decision weighs benefits and burdens. If the person lacks capacity, this is a best-interests decision under the Mental Capacity Act, and a health and welfare attorney with authority over life-sustaining treatment can make it.

It must be discussed with you

Doctors do not need consent for a DNACPR decision, but they do need to involve people. NHS guidance says the person must be told a decision has been made, and doctors should explain it and ask about their wishes. Information can only be withheld if telling them would cause physical or psychological harm, not simply because it would be upsetting. If the person lacks capacity, the senior doctor must consult those close to them, including any attorney or deputy. If there is no one, an independent mental capacity advocate (IMCA) should be involved.

This duty was confirmed by the Court of Appeal in the Tracey case in 2014, which found a failure to consult breached the right to respect for private life under Article 8 of the European Convention on Human Rights.

Blanket DNACPRs are unlawful

During the Covid-19 pandemic some care homes and GP practices were found to have applied DNACPRs to groups of residents without individual assessment. The CQC’s review “Protect, respect, connect” (2021) and a joint statement from the CQC, BMA, Royal College of GPs and others made clear that applying DNACPRs or advance care plans to groups of people is unacceptable. Every decision must be individual. If you find a DNACPR on your parent’s file that nobody discussed, ask the GP or care home why, and ask for a review.

ReSPECT forms

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It is a form used across much of England that records a person’s priorities and clinical recommendations for an emergency, including whether CPR should be attempted. It is written by a clinician together with the person or their family.

A ReSPECT form is not legally binding, but it is a strong guide for ambulance crews and hospital staff who do not know the person. Keep the original with the person, often in the care home file or at the front of a folder at home, and take it to hospital. Pack a copy with the documents in our care home packing checklist.

Advance decisions to refuse treatment

An advance decision to refuse treatment (ADRT), sometimes called a living will, is the only way a person can make a legally binding refusal of specific treatment for a future time when they lack capacity. The rules are in sections 24 to 26 of the Mental Capacity Act 2005.

Section 24: making one

• The person must be 18 or over and have capacity when they make it.
• It must say which treatment is refused, and can describe circumstances in everyday language.
• It can be withdrawn or changed at any time while they still have capacity. Withdrawal does not have to be in writing.
• It can only refuse treatment. It cannot demand a treatment or refuse basic care such as warmth, washing and offering food and drink by mouth.

Section 25: when it is valid and applicable

To refuse life-sustaining treatment such as CPR, ventilation or antibiotics for a life-threatening infection, the decision must:

1. Be in writing.
2. Be signed by the person, or by someone else in their presence and at their direction.
3. Be signed in the presence of a witness, who also signs.
4. Include a statement that it applies “even if life is at risk”.

It is not valid if the person withdrew it, later made an LPA giving an attorney authority over the same treatment, or acted in a way clearly inconsistent with it. It does not apply if the person has capacity at the time, if the treatment or circumstances are different from those described, or if there are reasonable grounds to think circumstances have arisen that the person did not anticipate.

Section 26: its effect

A valid and applicable advance decision has the same effect as if the person had refused the treatment at the time. Staff who withhold treatment because they reasonably believe a valid advance decision applies are protected. Staff who give treatment are only liable if they were satisfied a valid, applicable advance decision existed. The Court of Protection can decide disputes, and life-sustaining treatment can continue while a court decision is pending. This is why it matters to tell the GP, the care home and family that an advance decision exists, and where it is kept.

Lasting power of attorney for health and welfare

A health and welfare LPA lets a trusted person make decisions when the donor lacks capacity, including about medical treatment and moving into a care home. The attorney can only consent to or refuse life-sustaining treatment if the donor has expressly given that authority in the LPA. Registration with the Office of the Public Guardian costs £92 and takes several weeks. See how to get power of attorney and lasting power of attorney cost.

How to challenge a DNACPR decision

1. Ask questions. Ask who made the decision, why, and whether your parent was consulted. Ask to see the form.
2. Ask for a second opinion. In hospital, ask for the consultant. In a care home or at home, ask the GP.
3. Complain formally. Use the hospital’s or GP practice’s complaints procedure. For GP decisions you can also contact the integrated care board or NHS England.
4. Get support. Local Healthwatch and NHS complaints advocacy services can help.
5. Go to the ombudsman. The Public Service Ombudsman can investigate NHS complaints. If the issue was the care home’s conduct, see our guide on complaining about a care home.

A challenge may not change a clinical judgement that CPR would not work, but it should lead to a proper conversation and, where the process was wrong, a fresh decision.

Scotland, Wales and Northern Ireland

Scotland uses DNACPR forms under its own national policy and the Adults with Incapacity (Scotland) Act 2000; advance directives are not set out in statute but are generally respected. Wales follows the Mental Capacity Act 2005 and uses an all-Wales DNACPR policy. Northern Ireland’s capacity law is the Mental Capacity Act (Northern Ireland) 2016, which is only partly in force, so check current guidance.

For wider planning, see our guides to end-of-life care at home, palliative versus end-of-life care and fast-track continuing healthcare, which can fund care quickly when someone is nearing the end of life.

Frequently asked questions

Can a doctor put a DNR on my mum without asking the family?

A doctor does not need consent, but must consult. If your mum has capacity, she must be told and involved. If she lacks capacity, the senior doctor should consult family, any attorney or deputy, or an independent advocate. Failing to consult without good reason can breach human rights law, as the Court of Appeal found in 2014.

Does DNACPR mean no treatment at all?

No. DNACPR covers cardiopulmonary resuscitation only. Your parent should still receive every other appropriate treatment, such as antibiotics, fluids, oxygen, pain relief and hospital admission. If you think care is being withheld because of a DNACPR form, raise it with the doctor straight away.

Is a DNACPR form legally binding?

No. A DNACPR form records a clinical decision and guides staff, but it is not legally binding. A person who wants a binding refusal of CPR for the future should make an advance decision to refuse treatment that is written, signed, witnessed and says it applies even if their life is at risk.

Can a family member override a DNACPR?

Not on their own. Family must be consulted when the person lacks capacity, but the clinical decision rests with the senior doctor. A health and welfare attorney with authority over life-sustaining treatment can refuse treatment on the person’s behalf, but nobody, including an attorney, can insist on CPR that doctors believe will not work.

What makes an advance decision legally valid?

The person must be 18 or over with capacity when they make it, and it must name the treatment refused. To refuse life-sustaining treatment it must be in writing, signed, witnessed and include the words that it applies even if life is at risk, under section 25 of the Mental Capacity Act 2005. It must not have been withdrawn or overridden by a later LPA.

What is the difference between a ReSPECT form and a DNACPR?

A DNACPR form records only a decision about CPR. A ReSPECT form is broader: it records the person’s priorities and clinical recommendations for emergency care, including whether to attempt CPR. Neither is legally binding, but both are recognised by ambulance crews and hospitals.

Are blanket DNACPR orders in care homes legal?

No. Applying DNACPR decisions to groups of people, such as everyone in a care home, is unacceptable according to the CQC and professional bodies, and risks breaching human rights and equality law. Every decision must be made individually. If you find one that was never discussed, ask for an urgent review.

Sources

• NHS: DNACPR decisions
• NHS: Advance decision to refuse treatment
• Mental Capacity Act 2005, section 24
• Mental Capacity Act 2005, section 25
• Mental Capacity Act 2005, section 26
• CQC: Protect, respect, connect
• GOV.UK: Lasting power of attorney

General information, not legal or financial advice. Figures for 2026/27, checked October 2026.

Reviewed by The Care Panel team on 29 October 2026. This guide is general information about care in England, not legal, medical or financial advice. Rules and rates change; check with your council or an adviser before making decisions.