DNACPR Form England

DNACPR Is a Clinical Recommendation, Not a Legal Order

A Do Not Attempt Cardiopulmonary Resuscitation form in England is a clinical document. It records a senior clinician's assessment that CPR would not be medically appropriate — either because it would not work, or because the burden of attempted resuscitation would outweigh any benefit.

The critical point that most families miss: a DNACPR form is not legally binding. It does not carry the statutory force of an Advance Decision to Refuse Treatment under the Mental Capacity Act 2005. A DNACPR is a clinical recommendation that guides emergency teams, but it can be overridden by a doctor's clinical judgement in the moment.

This distinction matters enormously in practice. If you want a refusal of CPR to be legally binding on doctors, it must be documented in a valid, written, and witnessed ADRT that includes the statutory phrase "even if my life is at risk."

How a DNACPR Is Placed on a Patient's Record

A senior doctor — typically a consultant or registrar — makes the DNACPR decision based on a clinical assessment of the patient's condition and prognosis. The decision should involve discussion with the patient if they have capacity, or with their family and any registered Health and Welfare attorney if they do not.

However, the law does not require the patient's or family's consent. A doctor can place a DNACPR on a patient's record based on clinical judgement alone. The legal requirement is that the decision is communicated to the patient or their representatives — not that they agree with it.

This is the source of most DNACPR disputes. Families discover a DNACPR has been placed without their knowledge or against their wishes, and they feel powerless.

The ReSPECT Process — What It Changes

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a broader clinical framework that is replacing standalone DNACPR forms across many NHS trusts.

A ReSPECT form covers more than just CPR. It documents a patient's clinical priorities — whether the focus should be on life-prolonging treatments, comfort and symptom management, or something in between. It is designed to be created through a structured conversation between the patient (or their representative) and their clinical team.

Key differences from a standalone DNACPR:

• Scope. ReSPECT covers all emergency treatments, not just CPR
• Patient involvement. The process is explicitly designed to incorporate the patient's values and preferences
• Portability. The form is intended to travel with the patient between settings — hospital, care home, ambulance, GP surgery
• Still not legally binding. Like a DNACPR, a ReSPECT form is a clinical summary that guides emergency decisions. It does not override a valid ADRT or the authority of a registered Health and Welfare attorney

What Families Can Do When They Disagree

If a DNACPR has been placed and you believe it is wrong — either because the patient's wishes have not been considered, or because you think the clinical assessment is flawed — you have several options:

1. Ask for a formal review. Request that a different senior clinician reviews the decision. The original doctor should explain the clinical reasoning in detail.
2. Provide the patient's ADRT or LPA. If the patient has a valid ADRT that addresses resuscitation, or a registered Health and Welfare LPA where the attorney has authority over life-sustaining treatment, these documents take legal precedence over the clinical DNACPR.
3. Escalate within the trust. Ask to speak with the Patient Advice and Liaison Service (PALS) or the hospital's clinical ethics committee.
4. Apply to the Court of Protection. In extreme cases where clinical teams and families cannot reach agreement on a patient's treatment, an emergency application to the Court of Protection can obtain a binding declaration.

The most effective protection against unwanted DNACPR decisions is advance planning while the person still has capacity. A valid ADRT that specifically addresses CPR — combined with a registered Health and Welfare LPA — gives families a clear legal basis for challenging clinical decisions that contradict the patient's documented wishes.

The Planning Gap This Creates

Most families only encounter DNACPR decisions during a hospital admission or care home transition, when the emotional pressure is already intense. By that point, the patient may lack capacity to create new documents.

Our England Advance Directive guide walks through how to document CPR preferences in a legally binding ADRT, how the ReSPECT process interacts with existing advance decisions, and what to do when clinical teams and families disagree — including the exact verbal scripts for asserting your statutory rights on a hospital ward.

See more England guides →