DNACPR & Advance Decisions - Medical Ethics Medicine Interview Guide
- Suhaani Sathish
- 19 hours ago
- 8 min read
DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) is a clinical decision that CPR should not be attempted if a patient's heart stops. It does not mean "giving up" or withdrawing other treatments.
For medical applicants, understanding the ethical balance between a patient's autonomy and the clinical beneficence of withholding futile treatment is essential for interview success.
Decisions about whether to attempt resuscitation sit at one of the most ethically and emotionally complex interfaces in medicine. For aspiring medical students, whether you are preparing for medical school interviews or writing your personal statement, understanding DNACPR is essential.
This guide breaks down the principles, UK legal framework, communication challenges, and ethical reasoning behind DNACPR decisions, with exam-focused scenarios to help you think like a future doctor.
DNACPR Decisions & Medical Ethics: What Every Future Medical Student Needs to Know
DNACPR Explained Simply: DNACPR (“Do Not Attempt Cardiopulmonary Resuscitation”) is a clinical decision about withholding CPR only, not treatment withdrawal, not reduced care, and not “giving up.”
UK Legal Framework & Capacity: DNACPR forms are not legally binding, but ADRT (Advance Decision to Refuse Treatment) is; decisions follow GMC, BMA and Resuscitation Council UK guidance.
Ethics at the Heart of DNACPR: Decisions rely on autonomy, beneficence, non-maleficence and justice, key ethical pillars tested in medical school interviews and UCAT.
Communication Is Critical: DNACPR discussions require clear explanations, empathy, capacity assessment, sensitive dialogue, and reassurance that care continues.
Real-World Application for Medics: DNACPR scenarios appear in UCAT SJT and MMIs, involving patient capacity, best-interest decisions, family disagreements, and ethical reasoning on the ward.
What Is DNACPR? The Basics Every Applicant Should Know
A DNACPR order (“Do Not Attempt Cardiopulmonary Resuscitation”) is a medical decision that CPR should not be attempted if a patient’s heart or breathing stops. It does not mean:
“Do not treat the patient”
“Withdrawal of care”
“No escalation”
DNACPR only applies to the withdrawal of CPR.
They guide clinical decision-making, but doctors retain responsibility for determining whether CPR is appropriate at the time of arrest.
DNACPR decisions sit within a wider framework of advance care planning, including the ReSPECT form (Recommended Summary Plan for Emergency Care and Treatment)
In some cases, ADRT (Advance Decision to Refuse Treatment) is legally binding.
The UK Legal & Professional Framework Behind DNACPR
To understand DNACPR ethically, you must first understand the professional rules that govern it.
1. GMC Guidance
The General Medical Council emphasises:
Clear communication
Respect for autonomy
Best-interest decisions for those lacking capacity
Consulting family where appropriate, but not requiring consent for DNACPR if CPR would not be clinically appropriate
2. BMA, Resuscitation Council UK & Royal Colleges
Joint guidance states:
DNACPR should be made on an individual basis
No group of people (elderly, disabled, learning disabilities) should receive “blanket DNACPRs”
Patients with capacity must be consulted
DNACPR should be reviewed regularly and documented clearly
3. ADRT (Advance Decision to Refuse Treatment) and Legally Binding Refusals
If a patient with capacity has made an ADRT refusing CPR, it becomes legally binding if:
It is written
Signed
Witnessed
States explicitly that it applies even if life is at risk
Students often confuse DNACPR (clinical decision) with ADRT (patient’s legally enforceable refusal). Make sure to distinguish between the two!
👉🏻 Read more: Ceilings of Care
Ethical Principles Underpinning DNACPR Decisions
Understanding DNACPR requires a solid grounding in the 4 pillars of medical ethics.
Autonomy: A Patient’s Right to Choose
Autonomy means respecting a patient’s right to refuse treatments they do not want.
A patient with capacity can decline CPR even if the clinician disagrees, but doctors must confirm that the patient:
Understands their condition
Comprehends CPR success rates and risks
Is not under external pressure
Patients cannot demand CPR if the clinician believes it would be futile, but they have the right to be consulted.
Mock question: “How would you respond if a patient says, ‘I want CPR no matter what happens’?”
Strong answer: Start by exploring their understanding, provide honest information about outcomes, and discuss realistic expectations, without promising inappropriate treatment.
Beneficence: Acting in the Patient’s Best Interests
Doctors must aim to do good. CPR is a traumatic intervention with low success rates in frail or terminally ill patients. This is demonstrated in a study led by the British Geriatric Society looking at the success of CPR outcomes during the COVID-19 Pandemic.
If CPR has a negligible chance of success or is likely to cause harm (for example, severe rib fractures, prolonged suffering), beneficence may support a DNACPR decision.
Medical interviews commonly test the concept that “just because the medical team can do something for the patient, doesn’t mean they should.”
Non-Maleficence: Avoiding Harm
CPR can cause:
Rib and sternal fractures
Brain injury from hypoxia
Prolonged ICU stays
A DNACPR may be ethically justified to prevent disproportionate harm to patients - remember, the patient's welfare is your first concern.
Justice: Fairness and Anti-Discrimination
DNACPR decisions must never be based on:
Age alone
Disability
Learning disabilities
Socioeconomic status
This became particularly relevant during COVID-19, when some institutions were criticised for inappropriate “blanket DNACPRs”
Interview tip: Bring up justice when answering questions about fairness, policy, or resource allocation.
👉🏻 Read more: The 4 Pillars of Medical Ethics
Communicating DNACPR: The Real Challenge for Students & Doctors
Communication around DNACPR is often harder than the decision itself. Patients could fear that DNACPR means that a doctor is “giving up on them” or “withholding care.”
Effective communication includes:
Quiet, private setting
Clear explanation of CPR, survival rates, and likely outcomes
Empathy, silence, space for questions
Offering family involvement (with patient permission)
Acknowledging their emotions
Emphasising that care + symptom management will be ongoing
When students ask me how to approach these sensitive stations, I tell them that knowing the definition of DNACPR isn't enough. Many applicants fail these stations because they sound robotic or overly legalistic. In my professional experience, simply quoting the GMC guidelines won't show the empathy an interviewer is looking for.
This is precisely why we developed TheUKCATPeople's Medicine Interview Tutoring to provide a complete solution. We use role-play scenarios with qualified doctors to teach you how to navigate these emotional conversations with the right tone - something a textbook or self-study guide simply cannot teach you.
👉🏻 Read more: MMI Medicine Interview Tips Guide
Example Scenarios: DNACPR Ethics in Action
These scenarios mirror the style seen in UCAT Situational Judgement and medical school interviews.
Scenario 1: Patient With Capacity Declining CPR
An 82-year-old patient with severe heart failure says, “I don't want resuscitation. I just want peace.”
Questions you should consider:
Do they have capacity? (Considering whether they can Understand, Weigh Up, Retain, and Communicate the information you give them)
Do they understand what CPR involves?
Are they making a voluntary choice?
Have you explored their values, fears, and preferences?
Interview-style answer tips:
Acknowledge emotions
Provide clear information
Discuss prognosis
Respect autonomy
Document the conversation (if you were the doctor)
Scenario 2: Patient Without Capacity and No Family Present
A 74-year-old with advanced dementia arrests unexpectedly, and no DNACPR is in place.
Clinicians must decide whether CPR is appropriate in the best interests of the patient, considering:
Underlying illness
Likelihood of success
Known prior wishes (if they have any)
Burdens vs benefits
Scenario 3: Family Disagrees With a DNACPR Decision
The medical team decides that CPR would be futile. The family demands “Do everything.”
Key points:
Families cannot demand clinically inappropriate treatment
But they must always be listened to respectfully
Good communication is essential
Escalate concerns (senior doctor, second opinion)
Interview tip: Always emphasise empathy, transparency, and ensuring the family feels heard, rather than giving the impression that you are “overriding” them as a doctor - remember that the patient is their family.
👉🏻 Read more: Answering Medical Ethics Questions
Emerging Issues & Future Challenges in DNACPR
1. The ReSPECT process
Modern DNACPR decisions are shifting towards holistic emergency care planning.
2. The education gap
Multiple UK studies show:
Students rarely witness DNACPR discussions
They feel underconfident
Teaching is inconsistent
You can stand out in interviews by acknowledging this gap.
3. Ethical controversies
COVID-19 exposed inappropriate use of “blanket DNACPRs”, a great talking point in ethics stations.
4. Increasing emphasis on patient-centred care
Shared decision-making and advance care planning are now routine parts of good practice.
👉🏻 Read more: 280 MMI Medical School Practice Interview Questions
Potential Interview Questions on DNACPR In Medicine Interviews
In your medical school interviews, you need to be prepared to discuss DNACPR from both an ethical and communication perspective.
Potential Questions (Common)
What is a DNACPR order, and does it mean withdrawing all care?
A patient's family demands you perform CPR on their 95-year-old father, but you believe it is clinically inappropriate. How do you manage this?
Explain the difference between a DNACPR decision and an Advance Decision.
Why might a doctor decide to place a DNACPR order without the patient's explicit consent?
Less Likely Questions (Harder/Niche/Test Knowledge)
Discuss the 'blanket DNACPR' controversy during the COVID-19 pandemic and the ethical principles it violated.
How does the ReSPECT process differ from the traditional DNACPR form?
10 Key FAQs About DNACPR
1. What does DNACPR mean in the NHS?
DNACPR stands for Do Not Attempt Cardiopulmonary Resuscitation. It is a medical decision stating that if a patient’s heart or breathing stops, doctors will not perform CPR. It is strictly limited to CPR and does not affect other treatments like antibiotics, pain relief, or oxygen.
2. Is a DNACPR form legally binding in the UK?
No, a DNACPR form is a clinical guidance document, not a legally binding contract. It informs healthcare staff of a medical decision. The only legally binding document that can refuse CPR is a valid Advance Decision (ADRT), also known as a Living Will.
3. Can a patient with capacity refuse CPR?
Yes, a patient with mental capacity has the legal right to refuse CPR. Under the Mental Capacity Act, competent adults can refuse any medical treatment, even if doctors believe that decision is unwise or will lead to death.
4. Can a family override a DNACPR decision?
No, families cannot override a doctor's clinical decision regarding DNACPR. While families must be consulted to understand the patient's wishes (unless the patient requested otherwise), they cannot legally demand treatment that a doctor deems clinically futile or inappropriate.
5. Does DNACPR mean the patient receives no treatment?
No, DNACPR does not mean "do not treat." It applies solely to the act of restarting the heart. Patients still receive active care, which may include IV fluids, antibiotics, ICU admission, and palliative care to ensure comfort and dignity.
6. What ethical principles apply to DNACPR?
The four pillars of medical ethics guide DNACPR decisions:
Non-maleficence: avoiding the harm of invasive CPR that won't work.
Beneficence: acting in the patient's best interest (e.g., a peaceful death).
Autonomy: respecting patient wishes.
Justice: fair use of medical resources.
7. How is capacity assessed for a DNACPR decision?
To have capacity, a patient must meet four criteria regarding the decision. They must be able to:
Understand the information about CPR.
Retain that information.
Weigh the risks and benefits.
Communicate their decision back to the doctor.
8. Can a patient demand CPR if the doctor says no?
No, patients cannot demand clinically futile treatment. Doctors are not legally obliged to provide treatment they believe will not work or will cause more harm than good. However, they must explain the decision clearly and offer a second opinion if requested.
9. Why is communication important in DNACPR?
Poor communication is the leading cause of complaints regarding end-of-life care. Clear discussions prevent the misconception that care is being "withdrawn." It ensures the patient feels supported and that families understand the decision is based on medical reality, not resource rationing.
10. Why do medical schools ask about DNACPR?
DNACPR scenarios test a candidate's situational judgement (SJT) and ethical reasoning. They require students to balance medical law (Mental Capacity Act) with empathy, demonstrating they can handle conflict and sensitive conversations rather than just "curing" patients.
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