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Explaining DNAR/DNR orders

References to DNR orders are becoming increasingly common in discussions about care for older people.

But what are they and what do they entail?

There are so many acronyms – DNR, DNAR, DNACPR….

DNR stands for DO NOT RESUSCITATE. It is an old fashioned term and has since been replaced by DNAR or DNACPR. DNAR stands for DO NOT ATTEMPT RESUSCITATION and DNACPR stands for DO NOT ATTEMPT CARDIOPULMONARY RESUSCITATION.

In America, there are moves to develop and clarify the wording even further by using yet another acronym – AND – which stands for ALLOW NATURAL DEATH.

DNAR orders are also known as DNAR forms.

You can get expert information all about these forms from the UK Resuscitation Council website

A DNAR form is a document issued and signed by a doctor which tells the medical team not to attempt cardiopulmonary resuscitation (CPR) for a specified patient. The forms are used to help healthcare professionals to make quick decisions.

The forms exist because without them, the healthcare team will always attempt CPR.

A ‘DNAR decision’ is only about CPR and not about withholding any other treatment that a person may need or benefit from. DNACPR makes it absolutely clear that the decision refers only to CPR.

DNAR forms are not binding or legal orders. Professionals faced with making the best possible decision for a person at the time of a cardiorespiratory arrest will respect a DNACPR decision but may (and must have the freedom to) attempt CPR if they believe that the emergency they are dealing with is not what was envisaged when the decision was made and recorded. For example, a DNACPR decision, made to try to ensure a dignified death for a person with an advanced and irreversible condition, would not prevent attempted CPR if that person suddenly stopped breathing after choking on some food.

The British British Institute of Human Rights reports that around 80% of people dying in hospital do so with a DNAR order in place.

Only a doctor can make a DNAR decision or issue a DNAR form but, ideally, this should be done in consultation with the patient or their family.

Sometimes a doctor can issue a DNAR order even if the patient or their family disagree with the decision. This will happen if a doctor is convinced CPR would cause problems which would outweigh any possible benefits.

Medical experts say that patients and families mistakenly assume that CPR will keep patients alive and living as they were before. In fact, CPR has a low success rate in patients with certain diseases. For example, evidence relating to CPR for cancer patients shows that only 2.2% of cancer patients whose heart arrests in intensive care survive to hospital discharge.

Amidst the Covid 19 pandemic and the rising numbers of elderly people being admitted to hospital, there were worrying stories about blanket age policies for DNAR orders.

The Charity AGE UK has been highlighting their concerns about blanket DNAR policies

There have been high profile legal cases about DNAR orders resulting in recommendations for medics to discuss DNAR orders with patients and their families to avoid breaching an individual’s human rights.

The British Institute of Human Rights has profiled key legal cases relating to DNAR decisions

The Uk Resuscitation Council acknowledges that discussions about resuscitation can be difficult to carry out especially in emergency situations, when a patient is too ill to talk about such matters, and when staff are facing unprecedented pressures.

For these reasons, doctors encourage everyone to consider these issues in advance so that families understand our rights and wishes.

What our carents say

We just don’t talk about it - it’s too difficult

I can’t bear the thought of agreeing to a DNAR order for either of my parents – it feels like I would be giving up on them, condemning them

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