DNACPR Overview

Decisions about the provision of cardio-pulmonary resuscitation (CPR) have long raised difficult questions of policy and practice in care settings. CPR saves lives (although rather less frequently than you might think from watching TV!), but there also are circumstances where initiation of CPR is inappropriate. Decisions to initiate or to withhold CPR can be fraught and controversial — and must often be taken without time for reflection or discussion.  Adoption of DNACPR recommendations raises a further set of questions.  ‘DNACPR’ is an acronym; it stands for ‘Do Not Attempt Cardiopulmonary Resuscitation.’  What are the circumstances under which adoption of a DNACPR recommendation is appropriate? What are the appropriate processes for producing and reviewing them? And how they should be used in practice?

Particularly since the COVID-19 pandemic, ethical and legal issues about CPR and DNACPR have been an area of focus for the Autonomy Project research team and its partners. Building upon the findings of its ‘Human Rights in Locked-Down Care Homes‘ initiative, the Autonomy Project has been researching how decisions around cardiopulmonary resuscitation (CPR) are made. We are particularly interested in the use of so-called Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) recommendations – whether as self-standing recommendations or as part of a broader end-of-life care-planning exercise. Autonomy Project researchers Sabine Michalowski and Wayne Martin published an analysis of the legal framework around DNACPR in the Medical Law Review.

This set of interlinked webpages provide accessible information about CPR and the place of DNACPR recommendations in end-of-life care planning. Follow the links below, or watch the accompanying sketch-up videos, to learn more about the ethical and legal issues surrounding CPR decision-making, and about EAP research in this area.  The videos and linked text also provide information about the legal requirements for consultation in making DNACPR recommendations; the difference between a DNACPR recommendation and an advance decision to refuse CPR; about what to do if you are worried that an DNACPR recommendation has been made inappropriately; and about where to look for further guidance.

How to use the videos:   These pages include four sketch-up videos, produced by Autonomy Project researchers in collaboration with the creative team at We Are Cognitive.  Funding for creation of the videos was provided by a ‘Rapid and Agile’ grant from the University of Essex.  All four videos are included in small-frame format on the right column of this page.  You can either view them there, or follow the links at the bottom of this page to view them in a larger format.  Closed Captioning can be toggled on or off using the setting function for each video. The videos are made available for everyone on an open-access basis.  If have comments about them, or would like to use them free-of-charge in your own training programmes, please contact us at:  autonomy@essex.ac.uk.