DNACPR decisions come up at medical school interviews as ethics stations, as part of end-of-life scenarios, and as a knowledge check on what the form actually means. The ground is more specific than most applicants expect: a DNACPR applies only to cardiopulmonary resuscitation, it is a clinical decision rather than something a patient consents to, and the law requires it to be discussed with the patient. This article goes through why schools ask it, how to structure the ethical argument, and an example of a strong answer.
Discuss the ethics around CPR and DNR in the event of heart failure.
- Discuss the 2016 legal changes regarding Living Wills (Advance Decisions) and their ethical implications.
Why medical schools ask it
Ethical questions present a clinical or professional dilemma and test your ability to reason through it in a balanced, structured way. Resuscitation decisions are a good test because the two sides are both serious: CPR offers a chance of prolonging life, and in advanced illness it very often fails, causes harm, and takes the place of a dignified death. Interviewers want to see that you can hold both, apply the four pillars, and reach a reasoned conclusion rather than a slogan.
The topic also checks a piece of knowledge that applicants often get wrong. A DNACPR is a clinical decision that CPR will not be attempted if the patient's heart stops. It applies only to CPR: all other treatment and comfort care continues. Candidates who think a DNACPR means "no treatment" or "the patient has given up" reveal that they have not looked at the subject.
What interviewers are looking for
Across ethics stations interviewers mark for both sides weighed, the four pillars and GMC guidance used where they fit, patient safety addressed, and a clear, justified decision at the end. For this topic specifically, they also listen for:
- An accurate definition. DNACPR covers CPR only; everything else carries on.
- Realism about CPR. In advanced heart failure or frailty, success rates are low and survival with a good neurological outcome is rare, and the attempt itself causes rib fractures, brain injury and a distressing death.
- Who decides, and how. It is a clinical decision, but the patient (or those close to them, if they lack capacity) must be consulted. Discuss early and honestly, explain likely outcomes, and document the clinical recommendation and the person's wishes.
- The difference from an advance decision. A DNACPR is made by clinicians; an advance decision to refuse treatment is made by the patient while they have capacity, and is binding if valid and applicable.
How to structure your answer
Use the classical ethics structure: identify the issue, acknowledge both sides, apply the four pillars, relate to GMC guidance, and give a balanced conclusion with reflection. The model answer below does that for the CPR question, then again for advance decisions, which Manchester asks as the second part of the same station:
Part 1: Ethics of CPR and DNR in Heart Failure
1. Identify the issue
The core ethical issue is whether or not to attempt cardiopulmonary resuscitation (CPR) in patients with heart failure, and how to ethically justify decisions to implement or not implement a Do Not Resuscitate (DNR) order.
2. Acknowledge both sides of the ethical debate
Arguments in favour of CPR:
Arguments in favour of DNR:
3. Apply the four ethical pillars
4. Relate to GMC guidance
GMC guidance stresses the importance of honest communication, shared decision-making, and respecting patient autonomy. Doctors must avoid offering treatments that are clinically inappropriate while being sensitive and compassionate in discussions about resuscitation.
5. Balanced conclusion with reflection
In conclusion, CPR can be life-saving in selected patients but may cause harm or prolong suffering in advanced heart failure. Ethical decisions about DNR must balance respect for autonomy with realistic medical outcomes. This highlights the importance of early, sensitive discussions with patients and families, ensuring decisions respect dignity and values while upholding professional responsibility.
Part 2: Ethics and Law of Living Wills (Advance Decisions)
1. Identify the issue
The ethical issue here is whether patients should have the right to refuse life-sustaining treatments (such as CPR) in advance through a legally binding document, and how doctors should respond to these Advance Decisions ("Living Wills").
2. Acknowledge both sides of the ethical debate
Arguments in favour of Living Wills:
Arguments against Living Wills:
3. Apply the four ethical pillars
4. Relate to GMC guidance and 2016 legal changes
The GMC requires doctors to respect legally valid Advance Decisions. Following updates to the Mental Capacity Act clarified requirements, Living Wills must be written, signed, witnessed, and specific to the treatment being refused. GMC also advises doctors to confirm validity and applicability before acting.
5. Balanced conclusion with reflection
In conclusion, Living Wills provide an important mechanism for respecting patient autonomy, but they must be clear, current, and clinically relevant to avoid ethical conflict. Legal clarifications have strengthened safeguards and provided clarity for both patients and clinicians. This highlights the importance of advance care planning and sensitive communication, ensuring patients’ values guide care even when they cannot speak for themselves.
Three facts worth having ready
Since the Tracey case in 2014, a DNACPR decision must be discussed with the patient unless doing so would cause them physical or psychological harm; not wanting an awkward conversation is not a reason. Many hospitals now use the ReSPECT process, which records a patient's wider priorities for emergency care rather than a single yes or no on CPR. And a DNACPR is reviewed, so it is not permanent.
Example answer
A spoken answer to the first part of the station, about ninety seconds:
- The issue
- The question is whether to attempt CPR in a patient with advanced heart failure, and how a decision not to attempt it, a DNACPR, can be justified. It helps to say at the start that a DNACPR only covers CPR. The patient still gets every other treatment and all their comfort care.
- Both sides
- For attempting CPR: it is the only chance of prolonging life, some patients and families value that chance however small, and nobody wants to feel the team gave up. Against: in advanced heart failure CPR rarely works, survival with the patient's mind intact is rarer still, and the attempt itself means broken ribs, possible brain injury and a death that is violent rather than peaceful.
- Four pillars
- Autonomy means the patient's views have to be heard, and if they have capacity and want CPR attempted that carries real weight even where it is unlikely to work. Beneficence and non-maleficence point the same way here: if CPR cannot restore a life the patient would value, it does harm without benefit. Justice is about using resources and clinicians' time for care that helps.
- GMC and law
- GMC guidance says doctors should not offer treatments that are clinically inappropriate, but must discuss resuscitation honestly and sensitively, and since the Tracey case in 2014 the decision has to be discussed with the patient unless that discussion itself would harm them.
- Conclusion
- So I would say a DNACPR can be the right decision in advanced heart failure, but it has to come from an early, honest conversation with the patient about what CPR would and would not do, with their wishes recorded, and it should sit alongside a clear plan for the care they will still receive.
Practise this question out loud
Try answering it with the AI interviewer: it asks the question, follows up on what you say, and marks you against the points above.
Common follow-up questions
Resuscitation sits in a family of end-of-life questions. If you have the DNACPR facts, the capacity test and the difference between withdrawing treatment and assisted dying, you can answer all of them.
Discuss the legal position on living wills (advance decisions) and their ethical implications.
The second part of Manchester's station. Under the Mental Capacity Act an advance decision to refuse life-sustaining treatment must be written, signed, witnessed and state that it applies even if life is at risk. It binds if valid and applicable.
The doctor has to decide whether to keep her on life support. What should they consider?
Asked at King's and UCL. Best interests, the patient's known wishes, any advance decision, the views of those close to her, and the difference between withdrawing treatment that is not working and ending life.
What are your thoughts on euthanasia?
Reported at six schools. Assisted dying and euthanasia are illegal in the UK under the Suicide Act 1961. Withholding or withdrawing futile treatment is not euthanasia, and the distinction is the point of the question.
Should a doctor withhold a terminal diagnosis to keep a patient's spirits up?
Asked at Glasgow and UCL. Honesty is a GMC duty; the exception is a patient who has clearly said they do not want to know.
How would you assess whether a patient has capacity?
The first question in any resuscitation discussion is whether the patient can take part in it.
Common pitfalls
Things to avoid when answering the question:
- DNACPR means no treatment :
- It means no CPR. Antibiotics, fluids, surgery and pain relief all continue unless separately decided.
- The patient consents to a DNACPR :
- It is a clinical decision. The patient must be consulted and can decline a DNACPR, but they cannot demand CPR that the team judges futile, and they cannot sign one into existence.
- Not discussing it :
- Avoiding the conversation because it is uncomfortable is unlawful since Tracey. Say that you would have it early and honestly.
- Giving a one-sided answer :
- Ethical questions usually have legitimate arguments on both sides. Failing to acknowledge complexity suggests shallow thinking.
- Confusing it with euthanasia :
- Not attempting a treatment that will not work is standard medical practice, not ending a life.
- Forgetting to conclude :
- After exploring both sides, state your view. Sitting on the fence without reaching a reasoned conclusion is unsatisfying.
Which schools ask it
The two-part CPR and living wills station is reported at Manchester. End-of-life scenarios that depend on the same knowledge are reported at King's, UCL and Glasgow, and any school with an ethics station can ask about resuscitation.
Frequently asked questions
What does DNACPR stand for?
Do not attempt cardiopulmonary resuscitation. Older forms say DNR or DNAR; they mean the same thing. The wording was changed to make clear that it is CPR being withheld, not care.
Can a patient refuse a DNACPR?
A patient can say they want CPR attempted, and that view must be considered and recorded. But CPR is a treatment, and a doctor is not obliged to give a treatment that will not work. Where patient and team disagree, a second opinion is the usual next step.
How successful is CPR?
Less than most people think. For in-hospital cardiac arrest roughly one patient in five survives to leave hospital, and the figure is much lower in advanced illness or frailty. Out of hospital it is around one in ten. Interviewers like candidates who know that the television picture is misleading.