‘Do not resuscitate’ discussions: Can we do better?

COVID-19 must not be used as an excuse to avoid difficult discussions about Do Not Attempt CPR decisions.

Since the beginning of the COVID-19 pandemic, many have raised concerns about Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in the United Kingdom, claiming that they are being inappropriately applied to groups of people without their knowledge and proper consultation with their representatives. CPR is a treatment that can be given when someone stops breathing or their heart stops beating. It involves interventions like chest compressions, electrical shocks to the chest and artificial ventilation. DNACPR decisions should be made in consultation with patients themselves and are put in writing by their healthcare teams, when it is determined that CPR interventions would not produce beneficial outcomes. This may, for instance, be the case when someone has a very advanced cancer, and CPR would have zero chance of success. In response to the growing concerns about DNACPR decisions during the pandemic, the Care Quality Commission (CQC), England’s independent regulator of health and social care, conducted a special review. In its report on the matter, published in February 2021, the commission said that while it found some examples of good practice, it has also heard from people “who were not properly involved in decisions, or were unaware that such an important decision about their care had been made”.