DNACPR is not correctly 'a proxy marker for' 'expected death'

mike stone 14/03/16 Dignity Champions forum

I keep coming across clinically-authored protocols, which seem to be using 'do not attempt CPR on this patient' (DNACPR) as the equivalent of 'this patient's death is expected': I am so annoyed by this, that I feel the need to 'trash the idea' somewhere online.

Cardiopulmonary resuscitation (CPR) is the name given to an attempt to re-start a person's heart, if the heart has stopped beating. It is not usually successful, but it sometimes is. The purpose of 'expected death' is to modify the behaviour, when a patient who the GP feels sure is going to die very soon, dies at home: the purpose is to not involve police, etc, when the patient does die - and the point, is mainly to cover the possibility of the GP not being able to turn out to the death.

Those are two different things: CPR is about keeping a patient alive, and 'expected death' is about behaviour immediately after a patient has died.

REALLY SIMPLE ARGUMENT: imagine that there WERE NO TECHNIQUES AVAILABLE for CPR (imagine that clinicians had no way of attempting to restart a stopped heart) - the logical requirement for 'expected death protocols' WOULD STILL EXIST, but obviously DNACPR could not be used to indicate 'expected death'.

I have explained what should be done, for 'expected death':


It is true, that often a patient who is already so ill or frail that doctors feel certain that CPR would not successfully restart the heart if the patient arrested, should also be 'expected death' in terms of immediately post-mortem behaviour. But, patients can legally forbid attempted CPR (they can 'make themselves DNACPR') even if they are comparatively healthy, and therefore could not be 'expected death'. Although in reality, that turns out to be almost impossible to achieve, despite it appearing to be the patient's legal right - see the 'Alan and Liz' scenario a little way in to my piece (as 'QUESTION 1) at:


In theory, a clinician might agree to attempt CPR, if a patient had a really strong desire for CPR to be attempted, even if the clinician felt sure CPR would fail - which potentially has both 'attempt CPR but the patient is 'expected death'.

This inappropriate conflation of 'DNACPR' and 'expected death' is something we should strive to eliminate from protocols and guidance - it would be no harder, and MUCH BETTER, to get it right !