1. DNAR Jannany Raveendran Clotilde Kingsley

2. CASE STUDY You have witnessed Mrs Claus, an 81 year old lady, collapse in Aldi car park. You are the first person on the scene. She is found to be unresponsive, pulseless and making no respiratory effort. What would you do? Would you resuscitate?

3. What would you do now? You are about to start Cardiopulmonary resuscitation and you see this:

4. Would your actions be different if: She was 50 years old? You were the patients GP and knew their beliefs?

5. A DNAR decision should be considered when the patient: Does not wish to have CPR (having capacity or valid applicable advanced decision) Will not survive cardiac arrest even if CPR is attempted Where no explicit decision has been made in advance there should be an initial presumption in favour of CPR. Decisions about CPR must be made on the basis of an individual assessment of each patient’s case.

6. Advance care planning- CPR decision if risk of cardiorespiratory arrest. If the patient lacks capacity those close to the patient should be involved in discussions to explore the patient’s wishes, feelings, beliefs and values. DNAR only applies to CPR, other treatment should not be withdrawn

7. Advanced decision legally binding and valid if: ≥18 yo and had capacity when the decision was made The decision is in writing, signed and witnessed It includes a statement that the advance decision is to apply even if the patient’s life is at risk The advance decision has not been withdrawn The patient has not, since the advance decision was made, appointed a welfare attorney to make decisions about CPR on their behalf The patient has not done anything clearly inconsistent with its terms The circumstances that have arisen match those envisaged in the advance decision.

8. QUESTIONS?