DNACPR and Advance Decisions Explained

You may have come across the terms DNACPR, ReSPECT, or Advance Decision, sometimes all in the same conversation, and it's genuinely easy to lose track of what's what. Here's the plain-English version.

DNACPR: a clinical decision, not a legal document

DNACPR stands for Do Not Attempt Cardiopulmonary Resuscitation. It's a decision made by a treating doctor, based on their clinical judgement about whether CPR would genuinely be beneficial for that person, and it's recorded in their medical notes.

Two important things worth knowing:

• It covers CPR only, attempting to restart the heart or breathing if it stops. It does not mean any other care, treatment, or comfort is withheld.
• It's a clinical decision, not a legal one. A Health and Welfare attorney cannot simply demand or veto a DNACPR, though they must be properly consulted and their view genuinely matters under the Mental Capacity Act 2005.

ReSPECT: the wider conversation, recorded

You may also see a ReSPECT form, a wider summary of emergency care and treatment recommendations, not just CPR. It's built from conversations between the person (or their family, if they lack capacity), and their clinical team, and it's designed to guide decisions in an emergency when there may not be time for a fuller discussion. Like a DNACPR, a ReSPECT form is not legally binding, it's a summary and a guide, not an instruction clinicians must follow without judgement.

Advance Decision to Refuse Treatment (ADRT): the one that IS legally binding

This is genuinely different, and worth understanding clearly. An Advance Decision to Refuse Treatment, sometimes called a living will, is made by the person themselves, while they still have capacity, refusing one or more specific treatments in future circumstances they've clearly defined. Under the Mental Capacity Act 2005, a valid, applicable ADRT is legally binding, it overrides even a Health and Welfare attorney's decision for that specific treatment.

To make one, you must be 18 or over and have capacity at the time. You can refuse almost any treatment, including CPR, ventilation, artificial nutrition, or specific surgeries, but the refusal has to be specific and clearly worded. For decisions covering life-sustaining treatment, there are additional legal requirements the document must meet to be valid, this is worth getting right, ideally with proper advice.

How an ADRT and a Health and Welfare LPA relate

These are different tools that can work alongside each other. An LPA delegates decision-making to someone you trust; an ADRT is your own direct refusal of a specific treatment. Where both exist and cover the same treatment, a valid ADRT generally takes precedence, unless a later LPA explicitly overrides it. Many people find having both, each covering different ground, gives the clearest, most complete picture of their wishes.

A word from The Care Compass

These conversations are genuinely hard to have, and easy to put off. But having them while someone still has capacity, calmly, in their own time, tends to bring real relief, both to them, and to the family who might otherwise have to guess at their wishes during a crisis.

This article is for general guidance only and does not constitute legal or medical advice. For anything relating to an Advance Decision, especially covering life-sustaining treatment, professional legal advice is genuinely worth having.

You don’t have to navigate it alone.