Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether (a) families and (b) attorneys holding Power of Attorney are notified immediately when a DNR notice is added to a vulnerable adult’s medical record.

The Department remains clear that it is unacceptable for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions to be applied in a blanket fashion to any group of people and should be fully discussed with the individual and their family where possible and appropriate. NHS England clinical leaders have issued a number of statements and letters to health and care providers which emphasise personalised approaches to care and treatment and which reiterate that there has never been an instruction or directive issued by the National Health Service to put in place a DNACPR solely on the basis of disability, learning disability, or special needs.

Agreement to a DNACPR is an individual decision and should involve the person concerned or, where the person lacks capacity, their families, carers, guardians, or other legally recognised advocates. Guidance from clinical bodies such as the British Medical Association, the Resuscitation Council UK, and Royal College of Nursing reflects this. These decisions should take into account the patient’s wishes, or those of people close to the patient, informed by a sensitive explanation of the risks and burdens associated with giving cardiopulmonary resuscitation. The treating doctor should try to reach agreement with the patient or those close to the patient. If, after discussion, the doctor remains of the view that cardiopulmonary resuscitation would not be clinically appropriate, there is not an obligation to attempt it. However, the rationale for not doing so should be clearly articulated. NHS England has published public-facing guidance on DNACPR decisions on the NHS.UK website. This includes advice on asking for a second opinion or review if patients, or their families, disagree with a DNACPR decision.

The Department has not received any complaints regarding DNACPR decisions being applied without consent in the last five years.