A Question for Liz Taylor and Everyone: DNACPR forms or CNACPR forms, which should it be?
Hi Liz, and Everyone, I have a question. Please 'ask around' if you would be so kind, including on social media, and post here answers from friends, etc, as well as your own thoughts.
Our Mental Capacity Act makes it impossible for one clinician to order, by means of a form, another clinician to withhold attempted CPR. It would be possible if the law was different, but it isn't legally possible here. In the now fairly distant past, the terms DNR Order and DNAR Order were widely used for those forms. We now use ACPR - for 'attempt CPR' - but the forms are STILL using the DN part.
As I mentioned in a recent thread:
I asked the Ethics section of the BMA about this last week. What I wrote in one of the PDFs in the above thread, is:
I’ve asked the BMA, why we aren’t reading about, and being told about, CNACPR forms. While most people have twigged that DNACPR forms cannot be ‘Orders’, and these days they tell readers that they are ‘recommendations’, nobody seems to have noticed that DNACPR means Do Not Attempt CPR. And if the forms are recommendations, they are CNACPR forms – ‘Consider Not Attempting CPR forms’. If we want informed patients and relatives, then clinicians shouldn’t be saying ‘I’ll go away and complete a DNACPR form for you’ to patients on hospital wards when the reality is they are going to return with a completed CNACPR form.
If the patient notices that, and asks the doctor ‘Hang on – I told you I definitely don’t want CPR and I’m refusing CPR – but this form is only a recommendation’ then presumably the doctor will say ‘then you need an Advance Decision refusing CPR’. So, they complete an ADRT. The patient then says ‘This looks better – it says it is my decision to forbid CPR – so will this definitely stop anyone from attempting CPR?’. Let’s suppose the doctor says ‘Yes – it should’. Then the obvious comment from the patient, is ‘So we don’t need a DNACPR form, which is only a recommendation, when we’ve got my ADRT refusing CPR, do we?’.
So: do people think that clinicians should stop labelling those forms which are intended to try and prevent CPR from being attempted as DNACPR forms, and should instead re-label them to reflect what they actually are - CNACPR forms, standing for Consider Not Attempting CPR.
I think this is important - because the decision-making around CPR is so poorly understood, and calling 'a recommendation' a 'do not' is surely misleading?