Is a DNACPR decision legally binding?

No. GMC end-of-life guidance paragraph 129 says a recorded DNACPR decision is not, in itself, legally binding, and should be regarded as a clinical assessment and decision made and recorded in advance by the person with lead responsibility for the patient's treatment and care.

Do you have to tell a patient about a DNACPR decision?

Paragraph 134 says the judgement must be sensitively discussed with the patient unless discussion would cause them serious harm, and that serious harm means more than that the patient might become upset. You should not withhold information because the conversation is uncomfortable for you.

Can a family refuse to let you tell the patient?

No. Where the patient has capacity, the discussion belongs to them. You should be compassionate about the family's fears and explain how you will approach the conversation, but a relative's wish is not a basis for withholding it.

Does DNACPR mean no other treatment?

No. Paragraph 143 says a DNACPR decision applies only to CPR and does not imply that other treatments will be withdrawn or withheld. Other treatment and care continues if it is clinically appropriate and agreed to, or of overall benefit to a patient who lacks capacity.

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. Resuscitation Council UK describes it as a summary of personalised recommendations for care in a future emergency, recorded on a non-legally binding form, including a recommendation on whether CPR should be attempted.

Can a patient demand CPR?

Paragraph 138 says that if CPR would not be clinically appropriate there is no obligation to provide it, but you must explore the patient's reasons and expectations, give accurate information, and try to reach agreement. Where benefits, burdens and risks are finely balanced, the patient's request will usually be the deciding factor.

What happens if there is no DNACPR decision in an emergency?

Paragraph 145 says that where an emergency arises with no previous DNACPR decision in place and no time to establish the patient's views, CPR should be attempted, unless in your clinical judgement it will not be successful in restarting breathing and circulation.

DNACPR and ReSPECT — IMT Interview Ethics Station Answer

A DNACPR scenario at the IMT interview tests whether you know who makes the decision, who must be consulted, and what the decision does not mean. GMC end-of-life guidance answers all three, and ReSPECT gives you the conversation to have.

Key takeaways

GMC Treatment and care towards the end of life: good practice in decision making came into effect on 1 July 2010 and was updated on 15 March 2022 and 13 December 2024.
Paragraph 129 says a recorded DNACPR decision is not, in itself, legally binding, and should be regarded as a clinical assessment and decision made and recorded in advance by the person with lead responsibility for the patient's treatment and care.
Paragraph 134 says that where CPR will not be successful, this must be sensitively discussed with the patient unless it would cause them serious harm, and that serious harm means more than that the patient might become upset.
Paragraph 143 says a DNACPR decision applies only to CPR, and does not imply that other treatments will be withdrawn or withheld.
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. Resuscitation Council UK describes it as recording patient preferences and clinical recommendations on a non-legally binding form that can be reviewed and adapted, and which includes a recommendation on whether CPR should be attempted.
ReSPECT was developed by Resuscitation Council UK with the Royal College of Nursing, the British Medical Association and representatives of the public.

What is the principle behind a DNACPR decision?

The principle behind a DNACPR decision is that CPR is a treatment like any other, so it is offered when it may benefit the patient and discussed honestly when it will not.

GMC paragraph 128 describes what the treatment involves: chest compressions, electric shocks from a defibrillator, injection of drugs and ventilation of the lungs, with burdens including damage to internal organs, rib fractures, hypoxic brain damage and increased physical disability.

Paragraph 129 explains why a DNACPR decision exists. Where arrest is an expected part of the dying process and CPR will not restart breathing and circulation, discussing, making and recording the decision in advance helps the patient die in a dignified and peaceful manner.

Who makes the decision, and who must be consulted?

The DNACPR decision is a clinical one, made by the person with lead responsibility for the patient's treatment and care, but the GMC requires discussion before it is recorded.

Paragraph 132 says decisions must be based on the circumstances of the individual patient and take into account their wishes and preferences, and should involve the healthcare team and, with the patient's agreement, those close to the patient.
Paragraph 133 says that if a patient lacks capacity to make a decision about future CPR, you must consult those close to the patient as part of the decision-making process.
Paragraph 136 says that for a patient who lacks capacity you must consult any legal proxy and others close to them about the decision and the reasons for it, unless it is not practicable or appropriate, at the earliest practicable opportunity.
Paragraph 139 says that where there is no legal proxy with relevant authority, you must discuss the issue with those close to the patient and with the healthcare team, and must not give them the impression that it is their responsibility to decide.

Must you discuss a DNACPR decision with the patient?

Yes, unless discussion would cause the patient serious harm. Paragraph 134 of the GMC end-of-life guidance says a decision that CPR will not be successful must be sensitively discussed with the patient unless that would cause them serious harm.

The guidance then closes the obvious loophole. Serious harm in this context means more than that the patient might become upset, and you should not withhold information simply because conveying it is difficult or uncomfortable for you or the team.

Paragraph 134 also frames the purpose. The dialogue is to reach a shared understanding with the patient about their situation, the judgement and the reasons for it, and they have a right to seek a second opinion.

What is ReSPECT, and how does it differ from a DNACPR form?

ReSPECT is a process rather than a form. Resuscitation Council UK describes it as creating a summary of personalised recommendations for a person's clinical care in a future emergency in which they cannot make decisions or express wishes.

The difference from a standalone DNACPR form is scope. A DNACPR decision answers one question; ReSPECT places the CPR recommendation inside an agreed focus of care and a set of recommendations about other emergency treatments.

Reach a shared understanding of the person's current state of health and how it may change in the foreseeable future.
Identify what is important to the person in relation to goals of care in a future emergency.
Record an agreed focus of care, either more towards life-sustaining treatments or more towards prioritising comfort over efforts to sustain life.
Make and record shared recommendations about specific types of care and realistic treatment that should or should not be given.
Make and record a shared recommendation about whether or not CPR is recommended.

Resuscitation Council UK says the plan is created through conversations between the person and one or more health professionals involved in their care, should stay with the person, and should be immediately available in an emergency.

What is the worked scenario, answered aloud?

An 88-year-old woman with advanced heart failure is admitted overnight. Your registrar asks you to complete a DNACPR form before the ward round, and the patient's daughter says the family does not want her told. Said aloud, here is the answer.

I would not complete the form as a paperwork task. Paragraph 129 says the decision is made by the person with lead responsibility for the patient's treatment and care, so I would establish who that is and discuss it with them first.

I would check whether she has capacity for this decision. If she does, paragraph 134 says the judgement must be sensitively discussed with her unless that would cause serious harm, and being upset is not serious harm.

I would explain to the daughter that I understand her wish to protect her mother, that I will approach the conversation gently, and that the decision and the discussion belong to her mother while she has capacity.

I would use a ReSPECT conversation rather than a CPR question in isolation: what her health is now, what matters to her in an emergency, an agreed focus of care, then recommendations about specific treatments, and finally the recommendation about CPR.

I would make clear, as paragraph 143 requires, that a DNACPR decision applies only to CPR, and that her antibiotics, her fluids, her diuretics and her symptom control continue.

I would document the discussion and the decision in the record, which paragraph 142 requires, including a full note if a discussion did not happen and why.

What if the patient or family demands CPR?

If a patient with capacity wants CPR that you judge would not be clinically appropriate, paragraph 138 asks you to explore their reasons, their understanding of what CPR involves, and their expectations of the likely outcome.

Then it gives the balance point candidates miss. When the benefits, burdens and risks are finely balanced, the patient's request will usually be the deciding factor.

If after discussion you still consider CPR would not be clinically appropriate, there is no obligation to provide it, and you must explain your reasons and the options available, including the right to seek a second opinion. Paragraph 140 applies the same approach to a legal proxy's request.

What does the panel listen for in a DNACPR answer?

The panel listens for whether you treat a DNACPR decision as a conversation or as a form. A candidate who describes filling in paperwork has answered a different question from the one asked.

That you say a DNACPR decision applies only to CPR and does not limit other treatment.
That you know it is not, in itself, legally binding, and that it is a clinical decision by the person with lead responsibility.
That you discuss it with the patient unless doing so would cause serious harm, and that you know upset is not serious harm.
That you consult those close to a patient who lacks capacity, while being clear that they are advising rather than deciding.
That you can name ReSPECT and say what it adds beyond a CPR decision.
That you document the conversation, and document its absence with reasons.

The ethics, professionalism and governance area is weighted 1.2, scored 1 to 5 by each of two interviewers, inside a station whose communication mark is weighted 1.6, so the words you would use with the daughter carry real marks.

What is the trap in a DNACPR scenario?

The trap in a DNACPR scenario is agreeing not to tell the patient. A family's request is not a lawful basis for withholding the discussion from a patient with capacity, and paragraph 134 sets a high bar for doing so.

The second trap is treating a DNACPR decision as a ceiling of care. Paragraph 143 says you must make it clear to the healthcare team, the patient and those close to them that the decision applies only to CPR.

A third is forgetting reversibility. Paragraph 144 says a DNACPR decision should not override your clinical judgement if the patient arrests from a potentially reversible cause that was neither discussed nor envisaged when the decision was recorded.

How do you escalate a DNACPR disagreement?

Escalate a DNACPR disagreement rather than winning it. Paragraph 141 sends you to the guidance on resolving disagreements, which lists concrete steps before anything formal happens.

Involve an independent advocate, seek advice from a more experienced colleague, obtain a second opinion, hold a case conference, or use local mediation services.
In an emergency where there is no DNACPR decision and no time to find out the patient's views, paragraph 145 says CPR should be attempted unless, in your clinical judgement, it will not be successful.

How this comes up at the IMT interview

At the IMT interview, DNACPR and ReSPECT are a station 1 ethics, professionalism and governance scenario of up to five minutes, given after the six-minute exploration of your application and its two-minute presentation.

It also turns up inside station 2, when a deteriorating patient is frail or has advanced disease and the panel asks whether escalation is appropriate before you hand over.

internalmedicineinterview's bank of 361 IMT questions across 56 scenarios includes ethics-station scenarios with AI-marked spoken practice, so you can hear whether you had the conversation or described having it.

DNACPR and ReSPECT Conversations