How to Get a DNR Order in the UK

A Guide to Do Not Resuscitate (DNR) Orders in the UK

Facing a serious illness or thinking about end-of-life care can be really tough, and one of the important decisions that might come up is about a Do Not Resuscitate (DNR) order. While the formal medical term you might hear from doctors is "Do Not Attempt Cardiopulmonary Resuscitation" (DNACPR), many people, including healthcare staff, often just say "DNR."

Essentially, a DNR is a clear instruction to doctors and nurses that you don't wish for CPR (cardiopulmonary resuscitation) to be performed if your heart or breathing stops. This guide is here to walk you through how DNR decisions are made in the UK. We'll cover the steps involved, what the law says, and offer some advice to help you and your family understand this sensitive topic better.

What a DNR (DNACPR) Means for You

Let's start by understanding what a DNR, or DNACPR as it's formally known, is all about. CPR is a medical procedure used in emergencies to try and restart someone's heart and breathing. It can involve:

Chest Presses: Pushing rhythmically on the chest to pump blood around the body.
Help with Breathing: Giving breaths, sometimes with a mask and bag, or a tube that goes into the windpipe.
Electric Shocks: Using a machine to give an electric shock to try and get the heart beating normally again.
Medications: Giving drugs through a drip to help the heart.

While CPR can be lifesaving in some situations, especially for sudden problems in otherwise healthy people, it might not always be the best choice, especially if you have a serious illness that's getting worse, like advanced cancer, severe heart problems, or advanced dementia. In these situations, CPR can sometimes cause more harm than good, like broken ribs, lung damage, or even brain damage from lack of oxygen, without really helping you get better or improving your quality of life. Sometimes, it might just prolong suffering.

A DNR decision is all about making sure your wishes for end-of-life care are respected. It aims to prevent unnecessary discomfort and allow you to keep your dignity during your final moments. It helps make sure that the medical care you receive matches your personal values, beliefs, and what's most important to you about how you live your life.

It's really important to remember that a DNR order only applies to CPR. It doesn't mean that you won't receive any other medical care. You'll still get all the appropriate treatments for pain relief, managing other symptoms, or conditions like infections. The focus remains on making you comfortable and supporting your well-being.

Starting the Conversation About DNR

Talking about DNR can feel daunting, but it's a really important part of planning for your future care. Ideally, this conversation should come up naturally as you discuss your overall care preferences with your doctors.

If you have a long-term or serious illness, or if you're getting older and your health is declining, it's a good idea to bring up your wishes with your GP or specialist medical team. You don't have to wait for them to start the conversation.

These discussions can be emotional for everyone involved, but they are absolutely essential for making choices that truly reflect what you want and what matters most to you. Doctors and nurses are trained to have these sensitive conversations with kindness and understanding. You might start by saying something like, "I've been thinking about my future care, and I'd like to talk about what would happen if my heart or breathing stopped."

Talking with Your Healthcare Team

A DNR decision is a medical one, and it needs to be made in discussion with, and formally recorded by, a qualified healthcare professional. Usually, your main doctor (like your GP or a hospital consultant) will be the one to talk about DNR, especially if they believe:

CPR wouldn't work: Your underlying health problems mean it's very unlikely CPR would successfully restart your heart or breathing, or that you'd recover in a way that gives you a good quality of life.
CPR might cause more harm: The risks of CPR (like serious injuries or prolonged suffering) outweigh any possible benefits, especially if the outcome would be a very poor quality of life.
CPR wouldn't match your wishes: You've made it clear that you want to avoid aggressive medical interventions that might keep you alive but at the cost of your comfort or dignity.

These discussions can happen in different places, depending on your situation:

While you're in hospital: Often as part of planning your overall treatment if you're seriously ill.
At your GP surgery: For people with long-term conditions who are living at home and want to plan ahead.
In a care home: As part of your care plan, often with your GP and the care home staff.
In a hospice: This is a very common and important part of planning care when you're receiving palliative care.

Your healthcare professional should explain everything clearly, honestly, and sensitively, using words that are easy for you to understand, not complicated medical jargon. They should tell you about your likely future health, what might happen if you had CPR, and what choosing a DNR would mean.

Making the Decision Together

The decision to have a DNR order should be made collaboratively, meaning it involves you (if you're able to participate), your family or chosen representatives, and your healthcare team. Your wishes and what you prefer are the most important part of this whole process.

If you can make your own decisions: If you have the mental capacity to understand all the information and make your own choices, your wishes about DNR are legally binding. Doctors and nurses must respect them, even if they might think CPR could help. You have the right to say yes or no to CPR.
If you can't make your own decisions: If you're not able to understand or communicate your decisions (for example, because of advanced dementia, a severe brain injury, or if you're unconscious), healthcare professionals have a legal and ethical duty to make decisions that are in your best interests. This means they will:
- Talk to your family or legal representatives: This could be someone who has a Lasting Power of Attorney for health and welfare, or a court-appointed deputy.
- Consider any wishes you expressed before: This might be a formal "advance decision to refuse treatment" (sometimes called an advance directive), or simply things you've said informally when you were able to make decisions.
- Think about your known beliefs and values: What kind of person were you? What was important to you in life? What would you have wanted?
- Look at your medical situation: What are the chances of CPR working? What would your quality of life be like afterwards?

In cases where you haven't made any formal advance decisions and can't make choices now, your healthcare team will rely heavily on input from those closest to you to understand what you would have wanted.

Writing Down Your DNR Decision

Once a DNR decision has been carefully discussed and agreed upon, it's vital that it's properly and clearly written down. This usually happens on a specific DNR or DNACPR form. The exact form might look a bit different depending on where you are in the UK (for example, there are specific forms like the ReSPECT form or local DNACPR forms), but they all generally include:

Your Details: Your full name, date of birth, NHS number.
The Decision: A clear statement that CPR should not be attempted.
Why the Decision Was Made: The medical reasons and/or your personal wishes.
Date and Time: When the decision was made.
Healthcare Professional's Signature: The doctor or senior clinician who made the decision.
Confirmation of Discussion: Who was involved in the conversation (you, family, etc.).
Review Date: When the decision should be looked at again.

It's extremely important that this completed form stays with you if you move between different care places – for example, if you go from home to hospital, between different wards, or from hospital to a care home. This way, your wishes are always clear and respected by everyone involved in your care, no matter where you are. Copies should also be kept in your medical records (both paper and electronic), and you or your family will often be offered a copy to keep for your own records.

Your Rights and Legal Points to Consider

In the UK, DNR decisions are legally significant and must be respected by all healthcare professionals caring for you. There are some key legal and ethical ideas that guide this process:

Your Right to Choose (Autonomy): If you can make your own decisions, you have a fundamental right to choose what happens to your body and your medical treatment. This includes saying no to treatments like CPR.
Acting in Your Best Interests: If you can't make your own decisions, then choices must be made in your "best interests." This means taking into account everything relevant, including any wishes you expressed in the past.
Advance Decisions to Refuse Treatment (ADRTs): This is a formal, legally binding document you can make while you have capacity. It states specific treatments you would refuse in the future if you were to lose capacity. If you have a valid ADRT saying you refuse CPR, it must be followed.
Lasting Power of Attorney for Health and Welfare (LPA): This is a legal document where you choose someone (an "attorney") to make decisions about your health and welfare if you lose mental capacity. If your attorney has this power, they can make decisions about your DNR on your behalf, always guided by your best interests and any instructions or preferences you included in the LPA.

You and your family have important rights throughout this process:

Right to be Involved: If you have capacity, you have the right to be fully involved. If you lack capacity, your family or representatives have this right.
Right to Information: You and your family have the right to clear, accurate information about your condition, what might happen, treatment options, and what a DNR means.
Right to Challenge: If you or your family disagree with a DNR order, or feel your wishes aren't being respected, you have the right to challenge the decision. You can do this by:
- Talking more with your medical team to get more clarity or express concerns.
- Asking for a second medical opinion from another doctor.
- Using the hospital or Trust's formal complaints process.
- Contacting the Patient Advice and Liaison Service (PALS) in England, who offer confidential advice and support.
- Seeking independent legal advice for very complex situations.
Right to Change Your Mind: If you have capacity, you have the absolute right to change your mind about a DNR decision at any time. If you do, it's crucial to tell your healthcare team immediately so the documents can be updated and everyone involved in your care knows your new wishes.

Reviewing and Changing Your DNR Decision

DNR orders aren't set in stone; they should be looked at regularly, as things can change. This is especially important if your medical condition changes significantly (whether it gets better or worse), or if your own wishes or life circumstances evolve. Regular reviews help make sure your DNR decision is still right for you, medically appropriate, and always matches your current health, likely future, and personal wishes.

Scheduled Reviews: Often, there will be a date noted on the DNR form for when the decision should be revisited.
Reviews When Things Change: A review should also happen if:
- Your medical condition changes a lot.
- You want to talk about the decision again.
- New medical information becomes available.
- You move to a new medical team or care setting.

Any changes made to your DNR order – whether confirming it still stands, making alterations, or cancelling it completely – must be fully documented. This updated information needs to be clearly communicated to you (if appropriate), your family, and all healthcare professionals involved in your care. This prevents any confusion and ensures that your care continues to be respectful of your choices.

Helpful Tips for Families and Carers

Going through the DNR decision-making process can be an emotional and tricky journey for families and carers. Here are some friendly tips to help you through it:

Encourage Open and Honest Conversations: Create a safe space for your loved one to talk about what they want for their end-of-life care. These talks, even if difficult, are invaluable for truly understanding and honouring their wishes. Help them think about and express what a "good death" means to them.
Don't Be Afraid to Seek Support: Discussing end-of-life care can be really draining. Please don't hesitate to reach out for support from healthcare professionals (doctors, nurses, palliative care teams), counselling services, faith leaders, or support groups. Many charities also offer specific advice and emotional support for families going through this.
Stay Informed and Ask Lots of Questions: Learn as much as you can about your loved one's specific health condition, the treatment options available, and exactly what a DNR order means in their unique situation. Never feel silly for asking questions – big or small. If medical terms are used, ask for them to be explained in simple words.
Make Sure the Documentation is Clear and Accessible: Check that the DNR form is not only completed correctly but also easy to find and visible in your loved one's home, care home, or medical records. Make sure that everyone involved in their care (like their GP, district nurses, care home staff, and out-of-hours services) knows it exists and understands what it says.
Be an Advocate for Your Loved One: If your loved one can't make decisions for themselves, you might need to speak up for them. Make sure their past wishes, values, and best interests are the main focus of any decisions being made.
Remember What DNR Means (and What It Doesn't): Please remember that a DNR order is only about CPR. It absolutely does not mean "do not treat" or "do not care for." Your loved one will continue to receive all other appropriate medical care, comfort, and support to ensure their well-being.

Deciding on a DNR order in the UK is a very personal and often complex process that relies on clear communication, well-informed choices, and a deep respect for your wishes and right to make your own decisions. At its heart, it's about making sure you have dignity, comfort, and the best possible quality of life at the end, by avoiding medical actions that might not fit with your health goals or personal values. By having these open conversations with your healthcare team and loved ones, and by understanding the legal and ethical guidelines, you and your family can navigate the DNR decision-making process with more clarity, confidence, and peace of mind.