A Do Not Resuscitate (DNR) order or a Do Not Attempt Resuscitation (DNAR) order in the UK is a decision made by a medical professional that instructs the healthcare staff not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops or if they stop breathing. This decision is typically made to avoid causing the patient unnecessary suffering or harm.

Under UK law, once a DNR order is put in place as per the patient’s wish or, if the patient lacks capacity, the decision is made in their best interests by clinicians, it is legally binding. While doctors should consult with patients or their families when considering whether a DNR is appropriate, the ultimate decision does not lie with the family.

In the UK, family members cannot override a legally valid DNR order. If a family disagrees with a DNR decision, they can raise their concerns with the healthcare team. If the issue cannot be resolved, it may sometimes be necessary to take the matter to a court for a decision to be made.

For example, Parents cannot demand a DNR order is rescinded for their adult child if that child has capacity and has agreed to the DNR, neither can a husband demand CPR is attempted on his wife against her previously expressed wishes in a legally sound ADRT (Advanced Decision to Refuse Treatment).

It is important for families to have open and clear discussions about DNR orders and preferred end-of-life care with their loved ones, so any future decisions are made according to the person’s wishes. This is one of the main functions of creating an Advance Decision to Refuse Treatment (ADRT) like the ones you can fill in via myADRT. An ADRT allows people to state their wishes about refusing certain types of medical treatments, in case they’re unable to make or communicate these decisions themselves at a later stage.

Following on from our discussion about whether a family can override a Do Not Resuscitate (DNR) order in the UK, you may now have additional questions.

1. Does the medical team have to follow the ADRT?

An Advance Decision to Refuse Treatment (ADRT) is a legal document in the UK. Under the Mental Capacity Act 2005, doctors and healthcare professionals must respect an ADRT if it’s valid and applicable to the situation. If they ignore a valid ADRT and provide treatment that has been refused, they could face prosecution for assault. For example, if a patient has specifically mentioned in their ADRT that they must not be resuscitated even if their heart stops, then the medical team must respect this choice and not attempt resuscitation.

2. How do I ensure the validity of my ADRT?

An ADRT is valid if the person was 18 or over when they made it, had the mental capacity to make such decisions, and did so without any pressure or influence from others. To ensure it clearly states which treatments should be refused and under what circumstances, the ADRT could be shared with a GP or legal advisor for review. For instance, someone could refuse treatment that would keep them alive longer (life-sustaining treatment) such as resuscitation, ventilation, or artificial feeding. This has to be expressly stated in the ADRT with the phrase ‘even if life is at risk’.

3. Under what circumstances would an ADRT be considered ‘applicable’?

An ADRT is applicable when the person’s current circumstances match the situations described in the ADRT. For example, if someone has stated in their ADRT that they wish to refuse life-support treatment if they suffer from irreversible brain damage, the document would be applicable if medical diagnosis confirms such conditions.

4. Can anything change the validity or applicability of an ADRT?

Yes, if a person has done anything, after making an ADRT, that clearly goes against the decisions in it, their document may no longer be valid. This could be something like verbally expressing a change of mind, through their behavior, or if they have accepted treatment they chose to refuse in their ADRT. Furthermore, the ADRT may not be applicable if there have been significant advances in medical treatment since the creation of the ADRT. Returning to the earlier example, if a new treatment capable of reversing brain damage becomes available, the ADRT would not be applicable.

5. Who should be informed about my ADRT?

It is crucial to inform your close family members, legal guardians (if applicable), and your medical team about your ADRT. A copy of your ADRT should be placed in your medical records. You could also carry a personal copy or let someone know where it’s kept in case of emergencies. If you have made an ADRT on the myADRT platform, you can easily share it with the relevant people and institutions.

6. Can my family or Lasting Power of Attorney (LPA) for Health and Welfare challenge my ADRT?

While your family or LPA can question the validity or applicability of your ADRT, they cannot override your decisions if the ADRT is confirmed valid and applicable. Under the Mental Capacity Act, an ADRT takes precedence over decisions made by a health and welfare LPA. However, if you give someone an LPA after your ADRT, and give them the power to make decisions about the same treatments, then the LPA will have the final say, but only if your ADRT does not say it should be followed even if life is at risk. This can be a complex area, so it may be helpful to speak to a legal advisor, or engage with an organisation such as www.myadrt.com to ensure things are configured as you would like.

If you are considering creating an ADRT or updating an existing one, we encourage you to register your ADRT form with myADRT by visiting https://myadrt.com/register/  By registering with myADRT, you can ensure that your document is created, stored, and shared more efficiently with healthcare professionals and trusted individuals involved in your care.

Additionally, please consider sharing the myADRT service with your friends, family, or loved ones who may also benefit from having an ADRT in place. By spreading the word about this valuable service, you can help others take control of their future medical care and ensure their wishes are respected even when they are unable to communicate them personally. Registering an ADRT with myADRT is a proactive step towards peace of mind for both you and the people who care about you.