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<h3>Introduction</h3> Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) and wider end-of-life (EOL) decisions are increasingly common in emergency medicine. These decisions are often made under uncertainty, time pressure, and emotional intensity. Clinicians juggle ethical reasoning, clinical complexity, and sensitive communication in environments built for rapid intervention. Few studies have explored how emergency clinicians make these decisions in real time. This study examined how doctors and advanced clinical practitioners (ACPs) recognise dying, make DNACPR decisions, and speak with patients and families. <h3>Methods</h3> Semi-structured interviews were planned with UK emergency medicine clinicians, specifically doctors and ACPs who conduct DNACPR conversations. Recruitment used professional networks and social media to ensure national reach. Interviews explored recognition of dying, decision-making, communication, and contextual factors. Data were transcribed verbatim and analysed using Framework Analysis, chosen for its structured comparison across professional roles. <h3>Results</h3> Data were collected from August to November 2025. Seventeen clinicians participated from EDs across the UK. Decision-making was described as rapid, relational, and morally demanding. Recognition of dying relied heavily on intuition and pattern recognition but was limited by brief patient contact and missing information. DNACPR decisions required balancing reversibility and futility and were influenced by seniority and team consensus. Communication was often the hardest task. Clinicians aimed for honesty and clarity, yet worked in noisy, time-limited spaces that made sensitive conversations difficult. Emotional strain was common, especially when clinicians felt they could not provide the care they believed patients needed. <h3>Conclusion</h3> EOL and DNACPR decision-making in the ED is intuitive, complex, and emotionally challenging. This study offers early insight into how frontline clinicians navigate these pressures. Supporting earlier advance-care planning, team-based decision-making, and reflective practice may improve communication, confidence, and compassion in emergency EOL care.