Do Not Resuscitate Orders and LPAs: What Attorneys Need to Know

Written by James Tyrrell · Reviewed by Anthony Dalton · Last reviewed 9 April 2026

DNACPR decisions — often referred to as DNR orders — are among the most emotionally charged situations a Health and Welfare attorney will face. Understanding what authority an attorney actually has, and where the limits of that authority lie, matters enormously for anyone holding a Health and Welfare LPA.

What Is a DNACPR Order?

A Do Not Attempt Cardiopulmonary Resuscitation order — commonly referred to as a DNACPR or DNR — is a clinical instruction placed in a patient’s medical notes indicating that CPR should not be attempted if the patient’s heart or breathing stops. It is not a decision to withdraw care; it relates specifically to cardiopulmonary resuscitation.

CPR — which can involve chest compressions, electric shocks, and assisted ventilation — is not a benign procedure. It can be physically traumatic, and in many clinical contexts (particularly for frail or seriously ill patients) the likelihood of a successful outcome is very low. A DNACPR decision is made when a doctor concludes that attempting CPR would not benefit the patient and could cause significant harm.

Who Actually Makes the Decision?

A DNACPR is a clinical decision. It is made by the responsible clinician — usually the treating doctor or consultant — based on a medical assessment of whether CPR is clinically appropriate for that patient at that time. It is not a legal document in the same sense as an LPA or an Advance Decision.

This is one of the most commonly misunderstood points. Families sometimes believe that holding a Health and Welfare LPA gives them the power to approve or block a DNACPR. The reality is more nuanced.

• The clinician makes the clinical judgement — Whether CPR would be beneficial is a medical question, not a legal one.
• The attorney must be consulted — Where a Health & Welfare LPA exists, the attorney should be involved in the decision-making process as part of the best-interests assessment under the Mental Capacity Act 2005.
• The attorney’s views carry weight — Clinicians cannot simply ignore what an attorney says. They must take it seriously and be able to explain their clinical reasoning.

Can an Attorney Request a DNACPR?

A Health and Welfare attorney can communicate the donor’s known preferences and discuss the clinical picture with the medical team. If the donor had expressed a clear wish not to be resuscitated, the attorney can and should make that known. This is exactly the sort of information that should inform a DNACPR discussion.

However, an attorney cannot demand that a DNACPR be placed. The clinician retains responsibility for clinical decisions. What the attorney can do is ensure the donor’s views are heard, documented, and properly considered.

If the donor had documented their wishes in an Advance Decision — specifically refusing CPR — that document is legally binding on clinicians if it is valid and applicable, regardless of the attorney’s position. See our guide on LPAs and Advance Decisions for how the two documents interact.

Can an Attorney Refuse or Challenge a DNACPR?

This is where things become more complex. Where a Health and Welfare LPA explicitly includes the power to give or withhold consent to life-sustaining treatment, the attorney does have authority in that area. Courts have grappled with the relationship between that authority and a clinician’s DNACPR decision, and the position is not entirely straightforward.

In practical terms: if a doctor decides to place a DNACPR and the Health and Welfare attorney objects, the attorney’s objection cannot simply be brushed aside. The clinician must engage properly with the attorney, explain the clinical reasoning, and explore whether common ground exists.

If a genuine, irreconcilable dispute arises, the matter can be referred to the Court of Protection for a ruling. In urgent situations, clinicians can still act in what they believe to be the patient’s best interests, but a court challenge remains an option.

How an ADRT Refusing CPR Is Different

If a person has made a valid Advance Decision to Refuse Treatment (ADRT) that specifically refuses CPR in defined circumstances, and that ADRT is valid and applicable, it is legally binding on clinicians. Doctors must not attempt CPR in those circumstances, even if they would otherwise consider it beneficial.

This is fundamentally different from a DNACPR placed by a doctor. An ADRT is the person’s own legally documented refusal. A DNACPR is a clinical note. The legal weight of a valid ADRT is much clearer.

Donors who feel strongly about resuscitation should consider making an explicit ADRT alongside their Health and Welfare LPA. That gives their wishes the clearest possible legal footing.

Best Practice for Attorneys and Donors

• Include preferences in the LPA itself — The preferences and instructions section of a Health & Welfare LPA is the right place to record views on resuscitation. This does not bind clinicians, but it gives them clear guidance on the donor’s wishes.
• Consider making an ADRT for specific refusals — If the donor has clear views on CPR or other life-sustaining treatment, an ADRT is the most legally robust way to record those views.
• Engage early with the clinical team — Attorneys should not wait for a crisis. If the donor is admitted to hospital, the attorney should introduce themselves to the medical team and ensure the LPA is on record.
• Ask for explanations in writing — If a DNACPR is placed and the attorney has concerns, ask the treating doctor to explain the clinical reasoning clearly. This is a reasonable request.
• Know when to escalate — If a dispute cannot be resolved with the clinical team, a second opinion or a formal referral to the Office of the Public Guardian for guidance are both legitimate options.

Real Scenario: When an Attorney Disagrees with a DNACPR

David holds a Health and Welfare LPA for his mother, which includes the life-sustaining treatment authority. The hospital has placed a DNACPR in her notes following a recent deterioration. David believes his mother would have wanted everything possible done.

David’s first step is to ask the clinical team for a meeting. He explains his mother’s expressed wishes and asks for a clear explanation of the clinical reasoning. The team are obliged to take his views seriously. If David still disagrees after that discussion, he can request a second clinical opinion. If the dispute remains, the Court of Protection can make a determination. What David cannot do is simply instruct the team to remove the DNACPR.

The lesson is clear: attorneys have real authority, but DNACPR decisions sit at the intersection of clinical medicine and law, and navigating them requires engagement, not confrontation.

Common Questions About DNR Orders and LPAs

This guide was last reviewed and updated on 9 April 2026. Information is based on current legislation and OPG guidance for England and Wales.

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