Clinical Decision-Making on CPR and DNR Orders

In a 4 August 2026 parliamentary reply, the Ministry of Health (MOH) explained Singapore's clinical approach to decisions about cardiopulmonary resuscitation (CPR) and Do Not Resuscitate (DNR) status. The reply describes a clinical and ethical decision process, not a new statute, a blanket family-consent rule, or a promise that every hospital uses identical internal paperwork (MOH, 4 August 2026).

Patient capacity, preferences and best interests

Where a patient has mental capacity, the clinical team discusses treatment options with the patient and takes the patient's informed preferences into account. Where the patient lacks capacity, the team refers to any Advance Care Plan and considers information from family members or other people close to the patient about the patient's previously expressed wishes, values and goals of care. MOH frames the team's duty as providing care that is appropriate, compassionate and beneficial to the patient. The reply presents these sources of information as inputs to the clinical team’s best-interests assessment; it does not say that a family member automatically substitutes for the patient’s preferences or makes the decision alone (MOH, 4 August 2026).

CPR and DNR decisions

MOH states that in an emergency, whether CPR should be performed is ultimately a clinical decision by the team caring for the dying patient. The team considers the patient's clinical condition, the likelihood of meaningful recovery, pre-morbid functional status, overall prognosis and known previously expressed wishes. Where aggressive intervention is unlikely to reverse the condition or meaningfully improve outcomes and may prolong suffering, the focus of care may shift towards comfort, relief of suffering and dignity (MOH, 4 August 2026).

In a healthcare institution, a DNR status can record a decision made in advance, often for very ill or older patients. MOH says public healthcare institutions have processes that may include input from senior clinicians, multidisciplinary teams and, in complex cases, hospital ethics committees. The reply specifically says family members, including next-of-kin, cannot demand CPR when the treating team has assessed that it would not provide meaningful clinical benefit (MOH, 4 August 2026). This does not mean family views are irrelevant: they can provide evidence of the patient's wishes and help the team determine the patient's best interests.

Clarification, independent review and transfer

Families who have concerns about a DNR decision may seek clarification from the clinical team and, where circumstances permit, seek an independent clinical review. MOH says hospitals can facilitate such reviews and may also facilitate transfer to another healthcare institution when the family requests it and the transfer is clinically appropriate and safe. The reply therefore describes possible review and transfer pathways, not an automatic right to overturn a clinical decision or obtain transfer in every emergency. Whether a review or transfer can proceed depends on the circumstances and clinical safety; the reply does not name a single national form, fixed response time or guaranteed receiving institution (MOH, 4 August 2026).

Scope of the MOH clarification

The parliamentary reply explains the principles and institutional processes that MOH expects readers to understand; it is not itself a patient-specific DNR order, a criminal or civil penalty, or a universal form that replaces each institution’s clinical documentation. It also does not allow a general reader to decide whether CPR would benefit a particular person: that assessment depends on the patient’s condition, prognosis, capacity, wishes and the treating team’s professional judgment (MOH, 4 August 2026). In an actual emergency or dispute, the relevant clinical team and hospital process remain the practical point of contact. Family members may ask for explanation, review or a clinically safe transfer, but the reply does not promise a particular outcome. This boundary keeps national guidance, institutional procedures and bedside decisions from being treated as interchangeable.