DNAR: To Resuscitate or Not to Resuscitate?

‘Do not attempt resuscitation (DNAR)’ or ‘do not attempt cardiopulmonary resuscitation (DNACPR)’ orders have been regarded as the best way to ensure that patients are not resuscitated in clinically inappropriate circumstances, or against their wishes. However, the use of DNAR orders has become contentious in situations where individuals have not been informed or consulted before an order has been made, and recent legal cases have highlighted the need for good communication and record keeping. This chapter considers the legal and ethical issues associated with DNAR and DNACPR orders, including the rights of patients, ethical guidance and policies associated with their use, and regional and national variations in practices surrounding their use and implementation. After discussing evidence of misinterpretation and misunderstandings of the implications of such orders in clinical practice, which have an impact on patients’ autonomy and well-being, the chapter will conclude that compliance with ethical and professional guidance must be consistent and mandatory, and suggest the introduction of legal sanctions for non-compliance.