This article discusses ethical, legal and professional issues surrounding ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decisions in end of life care. The principles outlined throughout this article are applicable in any care setting. It explains what a DNACPR decision is, its relevance to clinical practice, and provides guidance on decision making and its implementation. The article also discusses the ethical considerations when discussing DNACPR decisions with patients and families, as well as the legal issues surrounding advance decisions to refuse treatment. Case studies are used to link theory to practice.