QuestionSBA
QuestionChoice
CPR should be discussed with the patient prior to making a decision on whether they should be for it or not.
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e
Proceed with full treatment and keep the patient for CPR
QuestionChoice
It is good practice to discuss patients' wishes regarding CPR even in cases such as this where it is unlikely to be successful. This is important to maintain an honest and transparent patient-doctor relationship
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a
Explore the patient's wishes regarding CPR
QuestionChoice
Although CPR is unlikely to be successful, it would be inappropriate to complete a DNACPR form without a discussion regarding the matter with the patient
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c
Complete a do not attempt cardiopulmonary resuscitation (DNACPR) as CPR is not likely to be successful
QuestionChoice
It would not be appropriate to ask the patient's family for their opinion without the patient's prior consent unless this was done in the patient's best interest. There are no signs to suggest that the patient lacks capacity in this case so it would be worth speaking to the patient first
32406
d
Ask the patient's family about their thoughts on CPR
QuestionChoice
Although CPR is unlikely to be successful, there is no reason why active treatment for the patient's stroke and cancer should not continue
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b
Explain to the patient why active treatment will not be offered
QuestionComment
Very good question. Finally some real quesmed stuff
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Ale
QuestionComment
but CPR is a medical decision? If the pt's decision was to be resuscitated it would probably be overriden anyway? "exploring the pt's wishes" sounds like the decision is being made by the patient
59510
QuestionComment
Guess it's about making the patient feel heard before telling them anyway
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subscriber
Prolapsed Fissure
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Amnesia Serotonin
Concept
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# Overview

A Do Not Attempt CPR (DNACPR) decision can also be known as Do Not Attempt Resuscitation (DNAR)

A DNACPR decision provides information to healthcare professionals present on the best action to take if an individual suffers a cardiac arrest. A DNACPR is recorded, normally on a CPR Decision form, but is not in itself legally binding. This means that a doctor can overrule an existing DNACPR if they believe the circumstances do mean CPR would be in the patient's best interests.

A DNACPR can be made if cardiac or respiratory arrest is an expected part of the dying process, and either CPR will not be successful, or if CPR may be successful but the clinical outcomes (e.g. trauma and prognosis) mean it is not clinically appropriate. A patient with capacity may also refuse CPR.

# Best Interests 

Doctors can ultimately make the decision to put a DNACPR in place if it is in the patient's _best interests_, even if the patient themselves or their family disagrees. However, following a legal case in 2014, doctors must engage the patient and those close to them on the decision to make a DNACPR, and inform them if the decision to make a DNACPR order has occurred.

# R (Tracey) v Cambridge University Hospitals NHS Foundation Trust, 2014 

Janet Tracey died in Addenbrooke's Hospital in March 2011. She had been diagnosed with terminal lung cancer and had subsequently been involved in a car crash, in which she sustained a spinal injury. She required ventilation in the Intensive Care Unit (ICU), and after attempts to remove her from the ventilator were unsuccessful, a DNACPR notice was placed in her medical notes. Neither Janet Tracey nor her family were consulted about or informed of this decision.

The legal case concluded in favour of Tracey, finding that her Human Rights had been breached. The case acknowledged that the decision to put a DNACPR in place is ultimately a medical decision, and patients cannot demand treatment. But, the case did result in changes to DNACPR guidance:

Firstly, the decision to not tell a patient about a DNACPR notice can no longer be based on the fact that telling them would cause “distress”. Only if discussing a DNACPR order would cause the patient “physical or psychological harm”, can doctors justify not discussing it. In other circumstances, doctors are legally obliged to discuss a DNACPR order that has been made.

Secondly, it used to be the case that doctors were not obliged to discuss a DNACPR decision if the clinical decision has been made that CPR would be futile. This case amended this, making it a legal obligation for doctors to inform the patient that a DNACPR decision has been made, regardless of whether or not CPR could ever be successful (i.e. futility of CPR is justification for doctors making a best interests decision to make a DNACPR order - even if the patient wants CPR, but doctors are still legally obliged to inform the patient that a DNACPR order has been made).

A DNACPR decision relates only to CPR, and is not a refusal of any other treatment.
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DNACPR decisions
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Ethics and Law
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In advanced care planning, it is essential to discuss patients' wishes regarding CPR, regardless of their prognosis.
An 85-year-old man with a background of metastatic prostate cancer is admitted to hospital with a stroke. On examination, he has significant left-sided weakness and sensory loss but no disturbance in cognition or speech.

Which of the following is the most appropriate next step in regards to advanced care planning?
a