If someone has told you there is a DNACPR form on your medical record, or on the record of someone you love, the question you most want answered is probably whether it means the doctors have given up. It does not. A DNACPR decision is about one specific treatment – attempted cardiopulmonary resuscitation – and nothing else. Every other form of care, treatment, pain relief and support continues exactly as before, and having a DNACPR on the record changes none of it.
DNACPR stands for “do not attempt cardiopulmonary resuscitation”. You may also see it written as DNAR or DNR. They all refer to the same thing (NHS – DNACPR decisions).
A ReSPECT plan is a broader document used in many parts of the UK. It records a recommendation about CPR alongside your wider preferences for emergency care – whether you would want to go into hospital, what matters most to you, which treatments you would want considered.
This guide explains what each of these is, who makes the decision, what say you and your family have, and how both differ from an advance decision to refuse treatment.
Quick summary
- A DNACPR decision is a clinical decision made and recorded by a doctor. It applies to CPR only and has no effect on any other treatment
- A doctor does not need your consent, but you must normally be told the decision has been made, and you have the right to be involved in the conversation
- A DNACPR form is not legally binding. It is a clinical record and instruction to healthcare staff
- ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a wider plan covering emergency care preferences, with a CPR recommendation inside it. It is also not legally binding
- An advance decision (ADRT) is the one document in this group that is legally binding in England and Wales, and it is written by you, not by a doctor
- ReSPECT is used in many parts of England and some parts of Scotland. Wales and Northern Ireland use different systems
What is a DNACPR decision?
A DNACPR decision means that if your heart stops beating or you stop breathing, your healthcare team will not attempt to restart it with CPR.
CPR is an emergency treatment. It involves repeated hard chest compressions, electric shocks to the heart from a defibrillator, artificial ventilation to move oxygen around the body, and medicines given by injection. It is a forceful thing to do to a body, and the NHS says so without euphemism: chest compressions “can cause bruising, break ribs and puncture lungs” (NHS – DNACPR decisions).
The same NHS guidance sets out the likely outcomes. CPR restarts the heart or breathing for between one and two in every ten people whose heart or breathing has stopped. Of those, only a minority go on to make a full recovery, and some are left with permanent damage to the heart or brain. The chances are lower where someone’s heart, lungs or other organs were already struggling – through previous organ damage, a serious long-term condition, severe current illness, frailty, or being close to the end of life.
That is the reason DNACPR forms exist. In the NHS’s own words, they mean “you do not receive a treatment that may prolong or cause suffering at the end of your life.”
Those figures describe outcomes across everyone who receives CPR. They are the background to the conversation, not the decision itself. A DNACPR decision about one person has to be made on that person’s own health, needs and priorities – which is why it is reasonable to ask the clinical team to explain what they expect in this particular case.
What a DNACPR does not mean
This is the point that causes the most distress, so it is worth stating on its own. The NHS guidance puts it in a boxed note: “DNACPR is about CPR only. It does not mean that you will not get care and treatment. You will continue to have all the other appropriate care, treatment and support you need.”
A DNACPR decision has no bearing on antibiotics, pain relief, fluids, oxygen, surgery, admission to hospital, intensive care, or anything else. It is one decision about one emergency treatment.
Who makes a DNACPR decision?
There are three routes to a DNACPR form being written, and they work differently.
| Situation | Who decides | What you should expect |
|---|---|---|
| You have capacity and decide you do not want CPR | You | Your doctor records your refusal on a DNACPR form. You can change your mind at any time |
| A doctor judges CPR would not work or would cause more harm than benefit | The doctor | Your consent is not required, but you should be told and given the chance to understand and discuss the reasons |
| You lack the capacity to decide | A senior doctor, after checks and consultation | They must first check for an ADRT or a health and welfare LPA, then make a best interests decision, consulting those close to you |
When the doctor decides
A DNACPR is a medical treatment decision, and a doctor can make it even if you disagree, because doctors are not obliged to provide a treatment they believe will not work. Two safeguards sit alongside that, and they matter. You must be told a DNACPR form has been or will be completed for you, and doctors may only withhold that information if they judge that telling you would cause you physical or psychological harm. And you should be given the chance to understand what a DNACPR is, how the decision was made, and why the clinical team thinks CPR would not be suitable, with your own wishes and preferences asked about (NHS – DNACPR decisions).
Each decision must be made person by person, based on that individual’s health, needs and priorities. Blanket decisions applied to a group – everyone living in a particular care home, or everyone over a certain age – are unlawful regardless of medical condition, age, disability, race or language. The NHS guidance states specifically that learning disability, autism and dementia are not reasons on their own to put a DNACPR on someone’s record.
A person with dementia can still have a DNACPR that was decided properly, where the clinical judgement rested on their overall health rather than on the diagnosis itself. If you are unsure which applies, asking the doctor to talk you through the clinical reasoning behind this particular decision is a fair and ordinary request.
When the person lacks capacity
If you have been assessed as unable to make this particular decision for yourself, the clinical team should first look for two documents:
- An advance decision to refuse treatment (ADRT) saying you do not want CPR
- A lasting power of attorney for health and welfare – and specifically one where you completed and signed the section on life-sustaining treatment, which is what gives your attorney authority over a CPR decision
If neither exists, a senior doctor makes a best interests decision under the Mental Capacity Act 2005. Before doing so they must ask the people important to you about your wishes and preferences. That includes anyone with legal power to represent you – an attorney, a personal welfare deputy appointed through the Court of Protection, a special guardian, or a parent where the person is under 16. Where someone has no family or friends appropriate to consult, an independent mental capacity advocate (IMCA) should be asked to represent them. The healthcare team’s own views should also be sought.
One limit applies to everybody, including attorneys: nobody has the right to demand CPR. An attorney can make a decision to refuse it, and can raise concerns and ask for a review, but cannot insist that it be given.
What is ReSPECT and how is it different?
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It was introduced in 2016 by Resuscitation Council UK, developed with healthcare professionals, members of the public and design experts at the Helix Centre at Imperial College London.
A standalone DNACPR form answers one question: should CPR be attempted? A ReSPECT plan sets that question inside a wider conversation about what you would want in any emergency where you could not speak for yourself. Resuscitation Council UK describes it as creating “a personalised recommendation for your clinical care in emergency situations where you are not able to make decisions or express your wishes.”
The plan is built through conversation between you, the health professionals involved in your care, and other people important to you. Version 3 of the form, current since September 2020, records:
- Your personal circumstances, understanding and perspective on your current state of health and how it might change
- What matters to you in decisions about emergency treatment and care, recorded on a visual scale
- Clinical recommendations for emergency care and treatment – including the option to record a recommendation balancing extending life against comfort and valued outcomes, rather than forcing a choice between the two
- A recommendation on whether CPR should be attempted
- Signatures, including an option for you, your legal proxy or a family member to sign, demonstrating that you were actively involved in the discussion
Where the plan lives and who reads it
The design intention is that the plan travels with the person rather than sitting in one organisation’s records. Resuscitation Council UK says it “should be available immediately to health professionals called to help you in an emergency, whether you are at home or being cared for elsewhere.” Ambulance crews, out-of-hours doctors, care home staff and hospital staff can all see it and act on it, so a team arriving in an emergency who has never met you before knows what was agreed.
What ReSPECT cannot do
A ReSPECT plan records preferences and agreed recommendations. It cannot be used to demand treatments that are unlikely to benefit you and that would not be offered. Version 3 of the form also carries a statement on its face confirming that the decisions recorded on it are not legally binding.
DNACPR, ReSPECT and advance decisions: the difference
The distinction that matters most is who writes the document and whether the law compels anyone to follow it.
| DNACPR form | ReSPECT plan | Advance decision (ADRT) | |
|---|---|---|---|
| Who creates it | A doctor, recording a clinical decision | A clinician and the person together, through conversation | You, while you have capacity |
| What it covers | CPR only | CPR plus wider emergency care preferences and treatment recommendations | Any specific treatments you name and refuse |
| Is your consent needed? | No – but you should be told and involved | It is built around a conversation with you | It is entirely your decision |
| Legally binding? | No | No | Yes in England and Wales, if valid and applicable |
| Legal basis | Clinical decision-making and professional guidance | Clinical process, Resuscitation Council UK | Mental Capacity Act 2005, sections 24–26 |
| Can it demand treatment? | No | No | No – it can only refuse |
The practical consequence: if you want your refusal of CPR to carry legal force for a future in which you cannot speak for yourself, the DNACPR form is not the document that does it. The NHS guidance is direct about this – “If you wish to make your DNACPR decision legally binding, you should write an Advance Decision to Refuse Treatment (ADRT).”
An advance decision refusing CPR also has to meet strict formalities, because CPR is life-sustaining treatment. It must be in writing, signed, witnessed, and carry a clear statement that it applies even if your life is at risk. Our guide to advance decisions and living wills sets out those requirements in full.
The two documents work well together. Many people have both: an ADRT recording a legally binding refusal, and a DNACPR or ReSPECT form making that refusal instantly visible to a paramedic who has thirty seconds to act.
Does this work the same way across the UK?
No. The underlying clinical principles are broadly consistent across the four nations, while the forms and processes differ, so it is worth checking what applies where you are.
| Nation | What is used |
|---|---|
| England | ReSPECT is widely used, alongside local DNACPR forms and treatment escalation plans in areas that have not adopted it |
| Scotland | A national DNACPR policy applies across NHS Scotland; ReSPECT has been adopted in some parts of the country |
| Wales | The All Wales DNACPR policy and its standardised national form. ReSPECT has not been adopted |
| Northern Ireland | ReSPECT has not been adopted |
Resuscitation Council UK states the position on adoption directly: “Many parts of England and Scotland have now adopted the ReSPECT process, while Northern Ireland and Wales are yet to adopt ReSPECT.” Its guidance adds that people “should not expect to use the ReSPECT process until it has been established in their locality.”
Scotland operates a national integrated adult policy on CPR decisions, published by the Scottish Government on 31 August 2016 and applying across NHSScotland, with its own standard DNACPR form (gov.scot – Cardiopulmonary resuscitation decisions: integrated adult policy). Decisions about treatment for adults who lack capacity in Scotland fall under the Adults with Incapacity (Scotland) Act 2000 rather than the Mental Capacity Act 2005.
Wales uses “Sharing and Involving”, the all-Wales clinical policy for DNACPR decisions for adults, launched in February 2015 and revised in 2017, 2020, 2022 and 2024. It comes with a standardised national form used across every care setting, and all new DNACPR decisions in Wales have been recorded on that form since 1 October 2015. NHS Wales makes the same point the NHS in England does: a DNACPR decision “would in no way alter any other aspect of achieving optimal care as DNACPR decisions refer only to CPR” (NHS Wales – DNACPR).
Northern Ireland has no ReSPECT process. The Department of Health has been developing an advance care planning policy for adults in Northern Ireland since 2021 (health-ni.gov.uk). Practice varies between HSC trusts, so your GP or the ward team is the right place to ask which form yours uses.
Common questions
Do I have to sign a DNACPR form?
No. A DNACPR form records a clinical decision, and your signature is not what gives it effect. The ReSPECT form is different: version 3 includes an option for you, a family member or your legal proxy to sign, which shows you were part of the conversation. Signing is not what makes it valid either.
Can I refuse to have a DNACPR?
You cannot veto a doctor’s clinical judgement that CPR would not work. You can ask for the reasoning to be explained, ask for a second opinion, and ask for the decision to be reviewed.
Where a doctor believes CPR could work and you want it attempted, that is a different conversation, and your wishes carry real weight in it. The DNACPR route exists for situations where the clinical team judges CPR would not achieve a sustainable recovery.
Can a DNACPR decision be changed or cancelled?
Yes. If you decide you no longer want a DNACPR on your record, tell your doctors and nurses so the form can be marked as no longer valid. The record that a form once existed stays on your notes, so that clinicians can see your full history and know what conversations took place.
Every DNACPR should also be reviewed. Some are written for a short period – a single hospital admission, for example. Others are written with no end date, where a long-term condition has damaged the heart, lungs or other organs, and are reviewed if the situation changes. You should be told when the review is due, and that date is usually written on the form. Good practice is to review it every time your situation changes, including when you leave hospital. If a form is added during a hospital stay, it goes into your discharge summary and is shared with your GP.
Do I have to talk about it at all?
No. You can tell your doctors and nurses that you would prefer not to discuss DNACPR, and ask them to note that on your record. You can change your mind later.
A doctor can still complete a form if they judge CPR would not prolong your life or would do more harm than good – and even then, you should still be told a form has been written, unless telling you would cause you physical or psychological harm.
How long does a ReSPECT plan last?
There is no fixed expiry. The plan is intended to be revisited when your health or your priorities change, and the recommendations updated to match. It is a record of a continuing conversation rather than a one-off form.
What if I disagree with a decision made about me or a relative?
Start with the doctor who made it. Ask them to explain their reasoning, and ask for a review and a second opinion.
If the person has capacity, they need to agree before the decision is discussed with you. If they lack capacity, family, friends and anyone with legal power to represent them – an attorney under a health and welfare LPA, for example – can raise concerns on their behalf.
If you are not satisfied with the response:
- GP decision – use the practice’s complaints procedure first, then contact NHS England
- Hospital decision – ask to speak to the senior doctor on duty or the consultant responsible for care, then use the hospital’s complaints procedure
- Either – your local Healthwatch can help you make a complaint, and you can be supported by an advocate
- Still unresolved – contact the Parliamentary and Health Service Ombudsman
Raising concerns is a reasonable thing to do, and clinical teams expect it. You are entitled to an explanation you can understand, to have your wishes and those of the person heard, and to a proper review by someone else. The outcome may still be that the decision stands, where there is a sound clinical reason for it – but the conversation itself often surfaces things the team did not know, and it is worth having.
Where to get help
- Your GP – the best first conversation, whether you want to understand a decision already made or start a conversation about your own preferences. They can also record an advance decision on your notes
- The hospital palliative care team – if the person is an inpatient, this team is experienced in exactly these conversations and can often explain a decision more fully than a busy ward round allows
- Resuscitation Council UK – ReSPECT – the organisation that developed the process, with information pages written specifically for patients and carers
- NHS – DNACPR decisions – the NHS’s own patient-facing guidance
- Compassion in Dying – free information and a helpline (0800 999 2434) on planning treatment decisions in advance
Deciding how you would want to be treated in an emergency is one part of planning ahead, and it sits alongside the other arrangements that make things easier for the people around you. These pages may help next:
- Advance decisions: your guide to living wills – the legally binding route to refusing specific treatments
- Lasting power of attorney: a complete guide – appointing someone to make health and welfare decisions for you
- Mental capacity assessment – how a doctor decides whether someone lacks the capacity to make a decision like this one themselves
- Planning ahead – the full set of things worth putting in place