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DNAR Does Not Mean No Treatment — SCE Palliative Medicine MCQ

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ModerateEnd of Life CareDNAR Does Not Mean No TreatmentSCE Palliative Medicine

A dying patient has a bilateral do‑not‑resuscitate order (DNAR) documented and a ReSPECT form completed. He develops a potentially treatable pneumothorax causing acute breathlessness. His performance status before this acute event was 40%. Should the pneumothorax be treated?

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Correct answer: C — Yes — a DNAR/ReSPECT decision not to attempt CPR does not preclude treating other reversible emergencies; chest drain is a distinct decision

In the UK, a DNAR decision applies only to CPR in the event of cardiac or respiratory arrest and does not preclude other appropriate treatments—even in those nearing end of life. The NHS guidance explicitly states that care and treatment should continue and patients should be fully assessed if they deteriorate.1 Moreover, ReSPECT is a plan to document wishes and clinical recommendations and includes a presumption in favour of potentially life‑sustaining treatment when doubt exists.2 Management of a pneumothorax with chest drainage is a reversible, potentially beneficial intervention separate from CPR and should be considered in line with clinical judgment and patient wishes. Court approval is not required, and family requests alone are not the driver; the decision rests on clinical appropriateness and the patient’s preferences.

Reference: NHS.uk – DNACPR decisions (NHS guidance, ~2.6 years ago); ReSPECT policy SFH (2023)