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CPR Presumption No DNAR — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyCPR Presumption No DNARSCE Medical Oncology

A patient with metastatic cancer has an unexpected cardiorespiratory arrest. No ReSPECT form, DNACPR decision or ADRT can be found, his views are unknown and the team must act immediately. What is the correct approach?

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

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Correct answer: B — Attempt CPR unless it is clinically judged unable to restart breathing and circulation in this arrest

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

E is correct. GMC guidance says that in an emergency with no previous CPR decision and no accessible patient view, CPR should be attempted unless clinical judgement is that it will not succeed in restarting breathing and circulation. Absence of a form creates an initial presumption, not an obligation to perform futile CPR. A removes the required contemporaneous clinical judgement. B gives a relative veto without legal authority and focuses on a downstream treatment rather than CPR success. C introduces a dangerous delay. D transfers a clinical decision to the family; relatives instead provide evidence about the patient’s wishes. The failure to plan should be reviewed after the emergency.

Reference: GMC end-of-life guidance on cardiopulmonary resuscitation: https://www.gmc-uk.org/professional-standards/the-professional-standards/treatment-and-care-towards-the-end-of-life/cardiopulmonary-resuscitation-cpr