A Do Not Resuscitate (DNR) order is a medically binding note of a patient’s wishes, refusing resuscitation if their heart or breathing stops. In the UK, it’s also known as a DNACPR order (Do Not Attempt Cardio-Pulmonary Resuscitation).

Generally, a DNR is highly respected by medical professionals, and they are instructed to honour it as part of a person’s right to consent or refuse medical treatment. However, this does not completely eliminate the possibility of a doctor overriding a DNR.

In some very rare and exceptional circumstances, a doctor may override a DNR, such as if the doctor believes that the DNR was created under influence or duress, or if the patient’s medical condition changes in such a way that it might invalidate the content of the DNR. In these situations, the doctor’s decision must be based on either their judgement that the DNR decision was not truly informed and voluntary, or that it’s no longer fitting with the patient’s best interests.

Here’s a hypothetical example to illustrate this: Let’s say the DNR is put in place for a terminally ill patient who doesn’t wish to be resuscitated due to the poor quality of life they anticipate post-resuscitation. However, what if during this patient’s hospital stay, they unexpectedly undergo a cardiac arrest due to a temporarily reversible condition like choking on food? In such situations, a doctor might decide to override the DNR and perform resuscitation, since the cardiac arrest was caused by a transient, correctable situation, differing from the scenario that the patient had imagined when they put the DNR in place.

However, overriding a DNR is a significant decision that is usually taken with utmost care and consideration. The medical team usually liaises with various parties such as the healthcare ethics committee, the patient’s family, or other medical personnel, in order to make the most ethically appropriate decision. This guideline also applies to advance decisions to refuse treatment (ADRT) made via platforms like myADRT, where a decision to administer any treatment against the specific instructions in the ADRT should involve review and consultation.

Following the discussion on whether a doctor can override a DNR (Do Not Resuscitate order), questions may arise on the specific instances when a physician may potentially override a patient’s wishes and if there are any regulations or safeguards in place to protect patients’ rights to self-determination in the UK. Further questions may also dwell on the differences between an ADRT (Advance Decision to Refuse Treatment) and a DNR, and whether one holds more weight legally. This is important to clarify as their interrelated nature can often confuse individuals.

1. In what conditions can a doctor override a patient’s wishes outlined in an ADRT?

In the UK, healthcare professionals are generally legally bound to respect an individual’s ADRT if it is valid and applicable. However, in some specific scenarios, they might potentially override a patient’s expressed wishes. Such cases mostly include situations where the individual has been considered mentally incapable of understanding the implications of their decision, i.e., they lack the mental capacity.

For example, if an individual had an ADRT refusing all types of medication for a heart condition, but then suffered a severe heart attack which they didn’t consider when making their ADRT, the doctor might judge that the situation is not covered by their ADRT and treat them anyway.

2. What safeguards are in place if a doctor overrides an ADRT?

Under the Mental Capacity Act 2005 in the UK, healthcare professionals are required to make a decision in the patient’s best interests when there is a justified reason for an override. They must take into account the patient’s past and present wishes, feelings, beliefs, and values, and consult other people close to lives, like family members, who can provide insight into what the patient’s wishes might be.

For example, if an individual with dementia had an ADRT refusing any form of life-prolonging treatment, and the treating doctor deemed that a mild form of medication would significantly improve their quality of life, they might override their ADRT. However, in doing so, the doctor would have to thoroughly consider the person’s best interests and consult with their family or any named health and welfare attorneys.

3. What is the difference between an ADRT and a DNR and which one is legally stronger?

An ADRT and a DNR have similar purposes – they both express a patient’s wishes regarding medical treatment for the future. An ADRT is a legal document that lets your healthcare team know your wishes about refusing certain types of treatment in the future. On the other hand, a DNR is a medical order written by a doctor which expresses a patient’s wish not to receive CPR if they stop breathing or their heart stops beating.

In terms of which document holds more weight, in the UK, ADRT is legally binding meaning it has the same effect as a decision made by a person with full capacity. A DNR, however, is more of a clinical guideline used by healthcare professionals, rather than a legally binding document. Nevertheless, doctors should always take a DNR seriously and not ignore the wishes of the patient.

Remember, making an ADRT or a DNR is a personal decision that should be made after careful consideration and discussion with your healthcare team and loved ones. Visit myADRT website (https://myadrt.com/) for more information and guidance on making this important decision.

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.