Palliative care offers physical, emotional and practical support to people with a terminal illness. It can be offered at any point after a terminal diagnosis.
What is palliative care?
If you are living with a terminal illness, you will usually have treatment and care which focuses on:
- managing any symptoms
- offering emotional, spiritual and psychological support
- offering practical support, including things such as planning for the future or getting equipment
- giving you a good quality of life
This type of holistic care, which looks after every part of you, is called palliative care. Palliative care aims to make sure you feel supported and comfortable, rather than cure the illness.
Palliative care is sometimes called ‘supportive care’
Palliative Care patients will often be aware that they are approaching end of life however some patients may lack capacity and not be aware. Our practice team is here to help guide you, your family and carers.
DNAR (Do Not Attempt Resuscitation)
DNAR stands for Do Not Attempt Resuscitation. The DNAR form is also called a DNAR order, or DNACPR order. The information in this section applies to people living in England and Wales.
What is a DNAR form?
A Do Not Attempt Resuscitation form is a document issued and signed by a doctor, which tells your medical team not to attempt cardiopulmonary resuscitation (CPR). The form is designed to be easily recognised and verifiable, allowing healthcare professionals to make decisions quickly about how to treat you.
It’s not a legally binding document. Instead, it helps you to communicate to the healthcare professionals involved in your care that CPR shouldn’t be attempted. These forms exist because without one your healthcare team will always attempt CPR.
The form only covers CPR, so if you have a DNAR form you’ll still be given all other types of treatment for your condition as well as treatment to ensure you’re comfortable and pain-free.
If you decide to have one, it’s a good idea to also make an Advance Decision (Living Will) refusing CPR. This will mean that your wishes are more likely to be followed if you lack capacity to make decisions.
Can I refuse CPR if I don’t have an ongoing condition?
You have the right to choose not to have CPR if you wish. If you don’t have an ongoing health condition and you choose not to have CPR, then you should write this refusal within a legally binding Advance Decision (Living Will).
Compassion in Dying can provide free Advance Decision forms or you can make an Advance Decision online at MyDecisions.
What if I change my mind or what if my situation changes?
You can change your mind at any time and your healthcare team should talk to you and give you any information you need to help you make a decision. Your healthcare team will also continually review both your condition and any decisions about CPR.
How is a DNAR form different from an Advance Decision (Living Will)?
An Advance Decision is a document that allows you to make a legally binding refusal of medical treatment in advance of a time when you can’t communicate your wishes or don’t have the capacity to make a decision. You can use it to refuse any treatment, whereas a DNAR form only applies to CPR. Anyone can write an Advance Decision for themselves.
A DNAR form has to be issued and signed by a doctor so you can’t write one yourself – although you can ask to have a discussion about CPR with your doctor.
In an Advance Decision you can specify the circumstance(s) in which you want the refusal(s) of treatment to apply, for example if you have been unconscious for a certain length of time. This means, if you wish, that you can refuse something only if you are in a certain situation. The majority of DNAR forms, on the other hand, will apply in every situation.
What does a DNAR form look like and will it be recognised?
National guidelines recommend that the same DNAR form should be used across the country to make them easily recognisable to healthcare professionals. However, despite these guidelines there is a large amount of variation between the types of form used. This means that what your form looks like and the wording it contains will depend on where you live and who issued it.
A DNAR form can be written for a specific time period, after which a new form would need to be issued if the decision still applied, or it can be written for an indefinite period of time, requiring no further review.
If you move care settings, for example from your home to a hospital, or from a care home to a hospice, then it’s a good idea to take the original signed DNAR form with you.
You or a loved one should speak to a member of your healthcare team before you move settings to discuss if the DNAR form will be recognised wherever you’re being cared for.
More information
The Resuscitation Council produces national guidelines and standards around DNAR decisions. These are available on their website.