CLINICAL DECISION-MAKING ON CPR AND DNR ORDERS

NOTICE PAPER NO. 1103
NOTICE OF QUESTION FOR WRITTEN ANSWER
FOR THE SITTING OF PARLIAMENT ON 04 AUGUST 2026

Name and Constituency of Member of Parliament
Dr Charlene Chen
MP for Tampines GRC

Question No. 1752
To ask the Coordinating Minister for Social Policies and Minister for Health (a) what guidelines and escalation processes are in place when a treating medical team determines that cardiopulmonary resuscitation is not clinically appropriate, despite objections from the patient's next-of-kin; and (b) whether there is a standardised process for obtaining an independent second clinical opinion or, where appropriate, arranging a transfer to another healthcare institution.

Answer

1        As our population ages and as a society, we will increasingly face difficult decisions regarding end-of-life care. These are often deeply emotional situations, and healthcare institutions will support patients and families through these periods with compassion, sensitivity and professionalism.

2        In this regard, the clinical team has a duty of care to their patient. They act professionally and ethically in the patient's best interests.  Their responsibility is to ensure that care provided is always appropriate, compassionate and beneficial to the patient.

3        Where a patient has mental capacity, the clinical team will discuss treatment options with the patient and take into account the patient's informed preferences. In situations where the patient lacks capacity, the clinical team will refer to any Advance Care Plan that the patient might have prepared.  Family members and other persons close to the patient can provide valuable information regarding the patient's previously expressed wishes, values and goals of care.  All this information helps the clinical team determine the treatment approach that would be in the patient's best interests.

4        There are often circumstances where the team determines that aggressive medical interventions are unlikely to reverse the patient's condition or will not meaningfully improve outcomes, and may instead prolong suffering. In such situations, the focus of care may appropriately shift towards comfort, relief of suffering and preservation of the patient's dignity towards end of life.

5        There will be emergency situations when the clinical team has to decide whether to perform cardiopulmonary resuscitation (CPR) for a dying patient.   This is ultimately a clinical decision by the clinical team caring for the patient. In making such decisions, the clinical team considers the patient's clinical condition, the likelihood that CPR will achieve meaningful recovery, the patient's pre-morbid functional status and overall prognosis, as well as any known wishes previously expressed by the patient.  It is a common institutional practice around the world that family members, including next-of-kin, cannot demand CPR when the treating team has assessed that it would not provide meaningful clinical benefit.

6        Often, especially for very ill and senior patients, resuscitation decisions can be made beforehand, which in a healthcare institution is called a ‘Do Not Resuscitate’ patient status.  Public healthcare institutions have established processes to support such decision-making. It may include seeking inputs from senior clinicians, multidisciplinary teams and in complex clinical cases, hospital ethics committees’ opinions. These processes help ensure that difficult decisions are carefully considered and appropriately reviewed.

7        Families who have concerns regarding a DNR decision may seek clarification from the clinical team and, where circumstances permit, seek an independent clinical review. Hospitals can facilitate such reviews and, where clinically appropriate and safe, may also facilitate transfers to another healthcare institution should the family request.