‘No Signature, No Consent’: Why Do Not Resuscitate Forms Must Involve Patients And Families.

If you have a friend or family member in hospital- please check if they have been issued with a Do Not Resuscitate form.

A Do Not Resuscitate (DNR) order is one of the most serious medical decisions that can be made about a person’s care. It means that in the event their heart stops or they stop breathing, medical professionals will not attempt to revive them. This is not a decision to be taken lightly — and legally, it must not be made without involving either the patient or, if they lack capacity, their family. Yet across the country, there have been alarming cases where families have only discovered a DNR was in place after the fact — often when it is too late to ask why, or challenge the decision.

Under UK law, and in accordance with General Medical Council (GMC) guidance, patients have a right to be involved in all decisions about their care, including CPR decisions. If the person has mental capacity, doctors must discuss the DNR with them directly. If the person lacks capacity, family members or a legal proxy must be consulted. In 2014, the Court of Appeal ruled that failing to consult a patient or their family about a DNR order is a breach of their human rights under Article 8 of the European Convention on Human Rights — the right to respect for private and family life. This means that any DNR decision made without consultation is not only unethical, it is unlawful.

There is no national law requiring a signature on a DNR form, but most NHS Trusts encourage patients or next of kin to sign as a clear record of agreement. What is legally required is documented evidence that a meaningful discussion took place. If no conversation occurred, or if it wasn’t recorded, the validity of the DNR can be challenged through legal or complaints channels. The NHS is clear that this process must be transparent, personalised and respectful — not rushed or secretive.

During the pandemic, a Care Quality Commission (CQC) investigation found over 500 cases in which DNRs had been issued without proper consultation. In some care homes, so-called “blanket” DNRs were placed on entire groups of elderly residents — decisions which have since been widely condemned and, in some cases, reversed. Families have reported discovering DNR orders on their loved ones’ records with no explanation and no prior discussion. In a time of immense stress and grief, this lack of communication only deepened their pain.

People across Havering and beyond deserve to know their rights when it comes to DNR decisions. Whether you are a patient, a carer, or a concerned family member, you are entitled to be consulted, to ask for a second opinion, and to challenge a DNR decision that you believe has been made unfairly or without consent. You can do this through the NHS complaints system or, if necessary, through legal action under the Human Rights Act.

Every person deserves dignity and respect at every stage of their life, including at the end. Decisions such as DNR must never be made behind closed doors. They must never be based on age, disability, or assumptions about quality of life. They must be made with compassion, clarity, and the full involvement of those most affected.

Let us be clear: no patient or family should ever be left in the dark when it comes to something as serious as a Do Not Resuscitate order. No signature? No conversation? Then no consent. And without consent, it is not just wrong — it is illegal.

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