A guide for carers
If you are caring for someone who has a serious illness or is in the final stages of their life, you may be having some very difficult conversations as they come to important decisions about their medical care.
We understand that talking about a Do Not Resuscitate (DNR) order can be confusing and emotionally challenging for both of you. Here we support you to understand the meaning, implications, and legal considerations of DNR orders, and offer practical advice on how you might create one, so you feel more informed and confident to uphold the wishes and preferences of the person you care for every step of the way.
A Do Not Resuscitate (DNR) order is a medical directive that lets others know that someone does not wish to receive cardiopulmonary resuscitation (CPR) if their heart stops or if they stop breathing.
Cardiopulmonary resuscitation (CPR) is a treatment used in an emergency to try and restart a person’s heart so they breathe again. CPR can include chest compressions, electrical shocks to stimulate the heart, injections of medicine and artificial ventilation of the lungs.
This order can also be called a DNACPR, which stands for Do Not Attempt Cardiopulmonary Resuscitation. It's also sometimes called a DNAR (Do Not Attempt Resuscitation).
People who choose to create a DNR order usually have a terminal illness or have a serious medical condition, or are near the end of their life. Someone might create a DNR order based on their health condition, how they feel about their quality of life, and their personal values.
A DNR decision is usually recorded on a special form and kept with someone’s medical records. Different doctors or hospitals might record it on different forms, like a DNACPR form, a treatment escalation plan, or a Recommended Summary Plan for Emergency Care and Treatment (ReSPECT); all these serve the same purpose which is to inform others of someone’s wishes not to have CPR if their heart stops.
The NHS have guidance here.
A DNR order ensures that each person involved with someone’s care respects their wishes and that any medical care they do receive aligns with their values and desires. A DNR order can prevent unnecessary suffering by avoiding potentially invasive treatments that may not improve someone’s quality of life.
A DNR also offers clear guidance to healthcare providers and carers about the preferred course of action in an emergency and so provides important clarity for everyone involved.
Having a conversation with the person you care for about their wishes regarding their medical care is the first step. If the person you care for wants to refuse CPR, you will need to fill in a DNR form. You can only get one of these from a doctor so you will need to make an appointment to speak with their GP or the doctor in charge of their care.
The final decision will be based on the wishes of the person you care for (providing they have capacity and can make an informed decision about their care), and on the opinion of their medical team. The DNR order can then be documented in their medical records. It often requires the signature of the healthcare provider and sometimes the person involved or their legal representative. You can print out this form and keep it in a safe place.
A DNR form can also be created by a doctor on behalf of somebody else. We explain why and how this works in the next section.
A doctor has to make decisions that are in the best interests of the people in their care; sometimes a doctor might feel it is most appropriate for a particular individual that CPR not be carried out and so they will create a DNR order on someone’s behalf.
This might be because they do not believe CPR will be successful, or will cause unnecessary distress. The treatments involved in CPR can be physically extreme and even if they are successful in restarting someone’s heart, they can leave a patient with extra injuries they may not be able to recover from.
If a doctor decides CPR is not medically appropriate for the person you care for and creates a DNR order, they should discuss their reasons with you and the person you care for to help you understand why they have come to their decision. They will then record this decision in their medical records.
As a carer, it can feel difficult to talk about these things with someone you care for, but it is important for you both. Having these conversations will ensure the person you care for feels confident, heard and respected, and that you are clear about their wishes at every stage. You will feel more empowered and confident by making sure you are fully informed about the DNR order and what it means. If you have any questions or something simply isn’t clear to you, your GP or healthcare team are there to support you and provide more clarification.
As their main carer, you might ensure that everyone involved, including family members and other caregivers, are aware of the DNR order and the decision the person you care for has made. Keeping a copy of the DNR order printed out and visible in an easily accessible place is also a great idea.
If anything changes, like they move to a different healthcare setting, their health deteriorates or their wishes change, you can support the person you care for by reviewing the DNR order with them and their healthcare team. This makes sure the DNR order is always up-to-date and reflects their current situation as accurately as possible.
In the event of an emergency, you can best support the person you care for by making sure those present respect the DNR order and CPR is not performed. It may be the most difficult situation you have ever been in, but your presence and the love and support you can provide for the person you care for will be hugely valuable to them, and knowing you have respected their wishes can be a comfort to you too.
Our guide to planning for an emergency may also be a useful resource.
Access Support
Joining a support group, whether in person or online, can provide a sense of community with others who will understand some of what you are going through. Sharing experiences with others who have gone through similar situations can be comforting.
Some answers to some common questions about DNA orders
A: No. A DNR order relates specifically to CPR. Someone with a DNR order will still receive other treatments, support and palliative care to manage their symptoms and make sure they are as comfortable as possible.
No. It’s important that a DNR reflects someone’s current wishes so it is vital that a DNR order is regularly reviewed and updated. This is especially important if someone’s situation changes, like they come home from hospital, their health status changes, or they go to live in a care home. If you are unsure whether a DNR order is still valid, you can ask your GP to check this for you.
A: Yes, a DNR order can be revoked at any time by the person involved or their legal representative. If the person you care for changes their mind about any aspect of a DNR order, it is essential to communicate any changes to their healthcare team immediately so it can be updated.
No. If you wish to make your DNR decision legally binding, you should write an Advance Decision to Refuse Treatment (ADRT). An Advance Decision is sometimes called a Living Will and in this case an ADRT can explain that you want to refuse CPR or other specific treatment. A choice to refuse life-sustaining treatment in an Advance Decision must be in writing, be signed by a witness and include a statement that the Advance Decision is to apply to the specific treatment 'even if life is at risk as a result'.
If the person you care for currently has capacity and wishes to make their refusal of CPR legally binding for a future time when they may not be unable to make this decision, then you can support them to write an Advance Decision to Refuse Treatment (ADRT). An ADRT will explain to a doctor or medical team that they want to refuse CPR or other treatments.
The person you care for may also wish to create a Lasting Power of Attorney (LPA). An LPA is a document that explains who they have chosen to be their ‘health and welfare attorney’ to help them make decisions or to make decisions on their behalf. If the person you care for would like their LPA to make decisions about CPR, then they must complete and sign the section on life-sustaining treatment in the LPA document. We have more information on LPA and what it means here.
If you are thinking about the future and making plans to support the person you care for, our article on Advance Care Planning may also be a useful support
A doctor will have created a DNR order having reviewed the entire situation and made a decision based on what they believe to be the best interests of the person you care for. Understandably, this can sometimes feel very hard to accept, and it might be that the doctor needs to explain to you in more detail why they have made this choice. You can ask them to explain their decision to you so you can understand it more clearly, and if you still disagree, you can ask for a second opinion.
It can feel daunting to question a decision like this, and our self-advocacy toolkit and other resources can support you in feeling more confident and empowered in this and other challenging situations.
A: Your presence will be hugely supportive to the person you care for when they create a DNR order. By simply being there to listen and respecting their wishes and feelings about these important healthcare decisions, you are ensuring that they feel heard and emotionally supported.
Absolutely yes. Conversations about DNR with someone we care for mean we are facing the reality of the end of their life and this can bring up all sorts of big feelings and challenging emotions. Allowing yourself to acknowledge and process these natural thoughts and feelings will make it easier for you to listen to the person you care for, even when it still feels hard. There is support available for you too as a carer, and our guide to Managing difficult emotions as a carer goes into more detail here.
As you take time to understand what a DNR order is and what it means, you are playing a crucial part in supporting the person you care for to make important decisions about their healthcare.
By respecting how they wish to live their life right up until the end, you are ensuring that their dignity and their individual needs and preferences are upheld at every stage.
Financial support
If you are at all worried about finances at this stage, you are not alone. It’s important to know that there is financial support available from your Local Authority in the form of benefits and grants. Our article on Getting financial support as a carer is a detailed guide to receiving the support you are entitled to.
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Visit our online support section where we have provided advice and guidance on a range of relevant topics to help you in your caring role.