Can you be forced to sign a Do Not Attempt CPR form (DNA-CPR)?

A DNA-CPR form states that Cardiopulmonary Resuscitation (CPR) is not to be performed on you if your heart has stopped beating.

CPR is an emergency procedure used to restart your heart and your breathing if they have stopped. It can include chest compressions, artificial inflation of the lungs, injections of medicine and electric shocks (defibrillation). While it can result in your heart and breathing restarting, patients will often need intensive care support and may be left with bruising or cracked ribs, brain damage or a punctured lung. In hospital, around two out of ten people survive and leave hospital after receiving CPR.

DNA-CPR forms have also been known as DNAR and DNR forms. They only relate to whether or not CPR is to be attempted. You may instead receive fluids, antibiotics and/or oxygen, amongst other things.

You cannot be forced to sign a DNA-CPR form.

However, there are news reports that people are being encouraged or even coerced into signing them and that health trusts are making wide-scale decisions on this issue without the consent of patients. Age UK and other age sector organisations have put out a statement on this issue.

Age UK’s position is that they understand that there are limited resources with which to treat people and that there are difficult decisions to be made during the Coronavirus pandemic. However, such fundamental decisions must not be made without consideration of an individual’s situation on a case by case basis. Nor should vulnerable, older or disabled people be made to feel that their life is less worthy than others and therefore that they should give up their chance to survive in favour of someone fitter, younger or less disabled.

In fact, medical professionals in the UK are able to decide whether or not to attempt CPR on a patient. However, they are obliged to discuss this with the patient or their family. Failure to do so is a breach of the patient’s human rights.

The British Medical Association has itself issued a statement with other medical bodies on this subject. In this, they state clearly that “it is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need.”

It is acknowledged by everyone that discussion around such subjects is especially important during the COVID-19 pandemic. The fact that health trusts and GPs are encouraging people to think about this in advance could be seen as a positive step – treating patients as adults and putting the facts in front of them and their families. However, it appears that, in the frenzied world of COVID-19 care, this is sometimes being done in an insensitive or inappropriate way.

People should be encouraged to consider what they want to happen if they become so unwell that they cannot have input into these decisions themselves. Talk to your family about your end of life wishes, make your views known. Prepare an Advance Decision setting out your instructions. And/or put in place a Lasting Power of Attorney for Health & Welfare if you haven’t done so already – this allows you to decide who should be able to advocate for you if you can’t make such decisions yourself.

There have also been questions about whether an Advance Decision can be used to insist on medical treatment. In fact, it can only be used to state your instructions to refuse medical treatment, it cannot be used to insist on treatment. It is a legal document in which you can state the types of life-sustaining care you do NOT wish to receive if you were in a situation where you were terminally ill, lacking the mental capacity to indicate your views and unlikely to recover.

You may wish to discuss this with a medical professional who knows your medical history and who can help you make these decisions.

Further advice

If you would like advice or assistance in the preparation of a Lasting Powers of Attorney for Health and Welfare, or Advance Decisions to Refuse Medical Treatment, please contact Ashtons Legal through this website or call 0330 404 0755 and ask to speak to a member of our Lifetime Planning team.

We will be happy to talk all of this through with you by telephone, or using video conferencing via Microsoft Teams, FaceTime or WhatsApp.

This information is correct at 10.00am on 15 April 2020.