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End of Life Decisions — MRCPsych Paper B MCQ

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HardOld Age PsychiatryEnd of Life DecisionsMRCPsych Paper B

An 85-year-old man with moderate dementia lives in a care home in England. He has been assessed as lacking capacity specifically to decide about cardiopulmonary resuscitation. He has no valid and applicable advance decision refusing CPR and has not appointed a health and welfare attorney with authority over life-sustaining treatment. After individual clinical assessment, the senior doctor concludes that CPR would not be clinically successful and records a DNACPR decision. His family have been consulted about his wishes but demand that CPR be attempted. Who is the decision-maker regarding DNACPR in this situation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — The senior doctor responsible for his treatment

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

B is correct. Dementia does not itself establish incapacity, but this man has been assessed as lacking capacity for the specific CPR decision. In the absence of an applicable advance decision or an authorised health and welfare attorney, the senior doctor makes the individual clinical and best-interests decision. The family must be consulted for evidence of the patient's wishes, feelings, beliefs and values, but next-of-kin status gives no power to demand or veto treatment. The care-home manager is not the treatment decision-maker. An IMCA represents an unbefriended person but does not make the decision; here appropriate family members are available. The Court of Protection does not have to decide every disagreement, although review, a second opinion, mediation or court involvement may be appropriate if a serious dispute remains unresolved.

Reference: NHS, Do not attempt cardiopulmonary resuscitation (DNACPR) decisions, section 'What happens if you are unable to make or discuss a DNACPR decision?', current page accessed 19 August 2026. https://www.nhs.uk/tests-and-treatments/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/