DNACPR's

Question 1

What is CPR?

Answer 1

This is an emergency procedure for people in cardio-respiratory arrest.

Question 2

What is DNACPR?

Answer 2

A Do Not Attempt Cardio Pulmonary Resuscitation document is a binding legal document that states resuscitation should not be attempted if a person suffers cardio-respiratory arrest.

Question 3

When do we consider this?

Answer 3

• CPR is unlikely to be successful (“futility”)
• The patient is mentally competent and does not want to be resuscitated
• Patient lacks capacity but has a legally valid advanced directive stating that they do not want CPR
• Resuscitation is not in the best interests of the patient because the quantity and/or quality of life of the patient following CPR is likely to be short/poor

Question 4

How to define futility?

Answer 4

In relation to the aim

Question 5

Competent pts?

Answer 5

Have the legal & moral right to refuse CPR and demand a DNACPR order.
• This right to refuse consent to treatment is vital to protect patients autonomy.

Question 6

Incompetent pts?

Answer 6

Where patients are incompetent, physicians must decide whether to issue a DNACPR order on the basis of best interests - MCA (2005)

Question 7

In practise?

Answer 7

• Effective recording of DNACPR decisions in a form that is recognized by all those involved in giving care
• Effective communication & explanation of DNACPR decisions (where appropriate) with the patient
• Effective communication & explanation of DNACPR decisions (where appropriate & with due respect for confidentiality) with patient’s family, friends etc.
Effective communication of DNACPR decisions between all healthcare workers & organizations involved with the patient

Question 8

Problems?

Answer 8

• Awareness and understanding of guidelines is poor.
• Many DNAR orders are made without adequate consultation with patients (or patients family)
• Health care professionals are often unaware that DNAR orders apply to CPR only.
• Discussions relating to DNAR orders are often inadequately documented in the notes.
Senior health care professionals should be making the decision regarding DNAR, but they are not always available when a decision needs to be made.

Question 9

What are advanced decisions?

Answer 9

An advanced decisions is an oral or written statement, made by a competent individual, about how they would like to be treated in the future if they happen to fall ill and are no longer competent to make decisions about their health care.

Question 10

Why are ADs opposed?

Answer 10

What reasonably healthy patients think they want when they are very ill is often not what they want when they are very ill
The advanced decision may not be specific enough
People may change their mind, but fail to communicate this fact
Problems of personal identity

Question 11

What are some legal caveats of AD’s?

Answer 11

• An advanced decision is not valid if:
• Before losing capacity the individual annuls the advanced directive
• There is evidence that the patient has changed his mind regarding the advanced directive.
• The advanced directive does not refer specifically to the situation at hand
• There are reasonable grounds for thinking that circumstances now exist, which the patient did not anticipate, & which would have affected the patients decisions had he anticipated them.
• The patient has created a lasting power of attorney since the advanced directive was written