This page contains answers to your frequently asked questions on emergency treatment plans, including the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process and Do Not Attempt CPR (DNACPR).
Below, you'll find a series of questions. When you click, you will see all of the answers on this topic.
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These questions relate to emergency treatment planning processes, including ReSPECT and DNACPR. To view the answers, click the question or the + sign next to the question.
Emergency treatment plans refer to processes that recommend what interventions may, or may not be, appropriate for someone if they become suddenly unwell. They are written by healthcare professionals to provide immediate guidance to those who have a duty to respond to medical emergencies.
Emergency treatment plans, such as ReSPECT and DNACPR, are not legally binding.
Historically, DNACPRs (Do Not Attempt Cardiopulmonary Resuscitation) have been used to provide recommendations about whether CPR should be provided in the event of cardiac arrest.
However, Resuscitation Council UK now encourages the use of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in clinical practice. The process allows clinicians to create personalised recommendations for a person’s clinical care and treatment in a future emergency in which they are unable to make or express choices. Recommendations are made through conversations between the individual, their families, and healthcare professionals and recorded on a plan which can be recognised across all care settings.
DNACPR only provides a recommendation not to attempt CPR if a person suffers a cardiac arrest. Whilst a person may have a copy of their DNACPR, it is generally held as part of their medical notes.
In contrast, as well as recording whether CPR attempts are recommended or not, the ReSPECT process provides a framework to help people and healthcare professionals discuss and record what other emergency treatments are recommended or not, so a shared understanding is reached. Once a ReSPECT plan has been written, a copy of this must be given to the person for them to keep hold of.
There are several reasons why it may not be appropriate for people to be offered, or receive, all available resuscitation and emergency treatments when they are unwell.
In some instances, this may be because the intervention may not be clinically appropriate for that person as it may be unlikely to offer any benefit or could even risk causing harm. In these circumstances, a healthcare professional should explain clearly to that person, or those close to them, why this is the case.
Some people may not wish to receive specific emergency treatments. In this circumstance, it is important for people to have the opportunity to discuss their wishes with a healthcare professional who can help that person make an informed decision about if this choice is right for them.
For CPR in particular, it is important people are given a full understanding of this treatment, its implications and if it will likely offer them any benefit if they suffer a cardiac arrest.
When someone’s heart and breathing stop because they are dying from an advanced and irreversible condition, CPR will subject them to a vigorous physical intervention that deprives them and those important to them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering.
CPR is by no means always successful in restarting the heart and breathing. When CPR is shown in films and TV ‘soaps’ they often fail to show the reality of what is involved and of the likelihood of success.
Recommendations in a person’s emergency treatment plan are intended to be read by healthcare professionals responding to a medical emergency. They are used to provide immediate guidance to help inform decision-making in an emergency.
A previously recorded recommendation not to provide CPR should not override clinical judgment at the time of an emergency.
If someone who has a DNACPR, or a ReSPECT plan where CPR attempts are not recommended, has a cardiac arrest due to an unforeseen and potentially reversible cause that was not envisaged when their plan was written, such as choking, then it may be appropriate for CPR to be provided until specialist help arrives.
Other examples of such reversible causes might include anaphylaxis, a displaced tracheal tube or a blocked tracheostomy tube.
An Advance Decision to Refuse Treatment (ADRT) is (as defined in the Mental Capacity Act 2005 – England & Wales) a legally binding document that the person has drawn up (when they had the capacity to make decisions) and in which they have stipulated certain treatments, such as CPR, that they would not wish to receive, and the circumstances in which those decisions would apply.
Where a properly made and applicable ADRT refuses CPR (acknowledging that their life would be at risk), a healthcare professional who knowingly disregards it and attempts CPR could be exposed to a civil claim for battery (unauthorised touching).
No, you don’t have to if you don’t want to.
However, if you want to be sure that what's important to you is respected it is important that people close to you know what they are and where they have been recorded.
A decision not to recommend specific emergency treatments, such as CPR, only relates to that specific treatment and should not affect the quality of care or any other treatment that you receive.
No. Each person is an individual whose needs and preferences must be taken into account in the context of their overall health and medical history. Blanket policies are inappropriate, whether due to medical condition, disability, or age. This is particularly important in recommendations around not resuscitating a person, which should only ever be made on an individual basis and in consultation with the individual or their family/Lasting Power of Attorney.
No. The recommendation whether to perform CPR should be discussed within the broader context of their overall goals of care and treatment. It is essential to understand what is important to them and what they would or would not want in an emergency. The recommendation on whether to perform CPR is only one part of this.
If a person is unable to contribute to recommendations (for example, because they are unconscious, too severely ill, or lack the mental capacity to participate in the discussion), the senior clinician responsible for their care will make the recommendation, whenever possible, after taking advice from those close to the person, such as family members.
Family members are not expected or entitled to make recommendations around CPR unless they have been given legal power (e.g. Lasting Power of Attorney) to make such recommendations on the person’s behalf.
If you have concerns or questions about the contents an emergency treatment plan, you should contact a clinician with senior responsibility for the care of the person the plan relates to, to discuss this further. In the community this could be a GP, or a consultant in hospital.
Further information for the public and healthcare professionals about the ReSPECT process can be found here.
The British Medical Association, Resuscitation Council UK and Royal College of Nursing have published detailed national guidance on decisions about CPR. Whilst this is written mainly to guide healthcare professionals, some members of the public have found it helpful when they were seeking answers to specific questions.
The NHS offers further information on DNACPR and ADRT decisions here.
In addition, for people with implanted cardiac devices (such as implantable cardioverter-defibrillators or pacemakers) Resuscitation Council UK, British Cardiovascular Society and National Council for Palliative Care have published detailed guidance for professionals, and (in collaboration also with the British Heart Foundation and Arrhythmia Alliance) an information leaflet for patients and their carers. Both resources can be found here.
Further information on decision-making towards the end of life and on ADRTs is available on the Compassion in Dying website.
These questions relate specifically to the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. To view the answers, click the question or the + sign next to the question.
If you have an ADRT, a healthcare professional might recommend you also have a ReSPECT plan.
A ReSPECT plan can be used to draw attention to the presence of an ADRT and should contain relevant aspects within the summary recommendations for treatment and care. If you would like to find out more about ADRTs, visit the NHS Advance decision to refuse treatment (living will) page.
This will depend on the region where you live.
In many areas where the ReSPECT process has been adopted, particularly in England, it has replaced DNACPR, and nothing additional is needed.
In some adopting areas, such as certain parts of Scotland, recommendations not for CPR still require DNACPR forms to be completed alongside a ReSPECT plan. The healthcare professional completing the process with you should advise you if this is necessary.
A ReSPECT plan summarises the emergency care aspect of a wider advance or anticipatory care planning process. ReSPECT records information to make it rapidly accessible to professionals who need to make immediate decisions about care and treatment in a crisis. An ACP or EOL plan document is usually longer and more detailed than ReSPECT. It is not restricted to planning for an emergency and is likely to contain more information.
Whilst a ReSPECT conversation should ideally be held face to face to facilitate effective communication and so a single version of a plan can be updated, you can have a ReSPECT conversation and update an existing plan by telephone, assuming you have the same version as the patient.
If a plan is updated or recommendations are changed, then a newly agreed copy of the plan must be sent to the patient, and the patient should be advised to score through the “old” plan and write ‘CANCELLED’ clearly on the plan.
Arrangements for the provision of ReSPECT training and resources are made at a local level. There should be a lead for ReSPECT in each locality. Please contact the ReSPECT lead in your area to find out what arrangements have been put in place. If you are unable to find out who is leading locally, then please get in touch, advising us of your locality, and we will try to refer your enquiry to the correct person.
These questions relate to the ReSPECT e-learning. To view the answers, click the question or the + sign next to the question.
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process supports healthcare professionals, individuals, and those close to them to have person-centred conversations about what care and treatment would be recommended for a person in the event of a future emergency where they are unable to make or express choices. It helps reach a shared understanding of what matters most to the person, their goals of care, and which treatments or interventions should be recommended in an emergency. The agreed outcomes of this conversation are recorded on a ReSPECT plan, which is given to the person so it can be available to help guide the decision-making of healthcare professionals who are responding in an emergency about what treatment and interventions, including CPR, are recommended and appropriate to help achieve that person’s overall goals for care.
The ReSPECT Essentials e-learning course is provided by Resuscitation Council UK (RCUK) to support healthcare professionals in understanding what the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process is and how it can be used in their practice to support person-centred emergency care and treatment planning. It is intended to provide a foundation upon which an organisation’s ReSPECT training programme can be built. Learners must also refer to their organisation’s ReSPECT policy for any additional guidance or training requirements their organisation has.
This course is intended to be completed by healthcare professionals who work for organisations that have adopted the ReSPECT process.
The course should be completed by healthcare professionals who, as part of their job role, are expected to:
The course is available via the NHS Learning Hub and is free of charge for the majority of users of this platform, including NHS trusts.
Access now through the NHS Learning Hub
If you do not have an NHS email address, you can register through the link below. This will give you access to the e-learning via the NHS Learning Hub.
The course is made up of three modules:
Whilst there is not a summative or final assessment, the course includes case studies to support application of learning to practice. A certificate of completion is issued to the user once the required modules and end-of-course survey have been completed.
The certificate of completion users will receive at the end of the course does not have an expiry date, as it is expected that adopting organisations state in their ReSPECT training policy how often they expect employees to complete this course.
The course takes approximately one hour to complete, but this will vary depending on which modules the user is required to complete for their job role.
No, the ReSPECT Essentials e-learning course is not CPD-certified at present.
Yes. Progress is automatically saved, and you can resume from where you left off.
In addition to some of the written content of the course having narration, and transcripts being available for videos in the course, the course has been designed to be compatible with screen readers. Care has been taken to ensure the course meets the accessibility standards required for NHS elearning for healthcare.
A SCORM file will soon be made available for integration with your organisation’s Learning Management System (LMS). You will be able to find the link here once it is available.
Whilst it is not mandatory, this course has been developed by Resuscitation Council UK to ensure that all healthcare organisations who have adopted use of the ReSPECT process can provide their employees with accurate information about how the ReSPECT process should be used in practice. To ensure that the content of the course is clinically and legally accurate and supports best practice, it has been reviewed by members of the team who helped develop the ReSPECT process and a wide range of subject matter experts from across the UK.
The course was developed to provide organisations who have adopted ReSPECT with a foundation upon which to build their ReSPECT training programmes and to help ensure that healthcare professionals who use ReSPECT can do so effectively. The course was designed so it can be used alongside adopting organisations’ local training resources.
Yes, the course is accessible to all healthcare professionals via the elfh platform. However, completion of the course does not permit the use of ReSPECT plans until your organisation formally adopts the process. For adoption enquiries, email info@respectprocess.org.uk.
These questions are for journalists interested in ReSPECT. To view the answers, click the question or the + sign next to the question.
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a UK wide emergency care and treatment planning process led by Resuscitation Council UK (RCUK). It supports conversations between people and healthcare professionals about what would matter most to them in a medical emergency if they are unable to make or communicate decisions. These discussions result in personalised clinical recommendations for emergency care, recorded on a ReSPECT plan held by the patient and can be transferable across all care settings. ReSPECT is the only emergency care and treatment plan intended for use across all ages and all four UK nations, and RCUK advocates its adoption as a national standard to promote consistency and parity.
ReSPECT enables person centred conversations about care and treatment in a future emergency, when individuals may be unable to communicate their wishes. By discussing values and goals of care in advance, clinicians and patients can agree realistic treatment recommendations, including about CPR, as part of a broader discussion about that person's goals for care. These recommendations are recorded on a ReSPECT plan, a nationally recognised clinical document that is transferable across all health and care settings. The plan belongs to the individual, crosses organisational and geographical boundaries, and supports clinicians to make informed, individualised decisions in an emergency.
No. ReSPECT and other forms of emergency care and treatment plans, such as DNACPR, are not legally binding documents (this is why they should not be called DNACPR decisions). Rather, they represent clinical recommendations based on an individual’s current clinical condition and values, designed to guide immediate decision-making in future emergencies.
A DNACPR (do not attempt cardiopulmonary resuscitation) is a clinical recommendation not to attempt CPR, made and recorded in advance, to guide those present should a person have a cardiac arrest.
A recommendation not to attempt CPR applies only to CPR. All other appropriate treatment and care for that person should continue. If a patient sustains a cardiac arrest due to an unexpected and potentially reversible cause (e.g. choking), then CPR can and should be attempted, even if a DNACPR is in place.
ReSPECT plans are developed through conversations between an individual and their healthcare team to record personalised recommendations for care and treatment in a future emergency. A ReSPECT conversation can be initiated by either an individual or a healthcare professional. People may choose to start a conversation to plan ahead or ensure their treatment preferences are known, while healthcare professionals may introduce it following a change in circumstances, such as hospital admission, a new diagnosis, or as part of routine care.
There are no age thresholds or specific risk scores that trigger a ReSPECT conversation. While it is particularly relevant for people with serious or complex conditions, ReSPECT can be used by anyone who wishes to plan ahead for emergencies, regardless of age, and is especially important at key points in a person’s health journey when their ability to communicate may be impaired, including towards the end of life.
While Resuscitation Council UK cannot comment on individual cases, ethical and legal guidance is clear that patients who have capacity should ordinarily be involved in discussions about CPR and the wider ReSPECT process. UK case law and professional standards start from a strong presumption of patient involvement, with consultation only avoided in rare circumstances, such as when it would cause significant physical or psychological harm.
If a patient has previously stated that they do not wish to discuss end of life issues, this preference should be respected and documented. In other circumstances, a clinical recommendation not to attempt CPR , particularly where it is unlikely to be successful, should be communicated with care and sensitivity.
The ReSPECT plan records whether the patient has been consulted and informed; completing this section without an appropriate discussion is not consistent with the principles of ReSPECT. Where a patient lacks capacity, healthcare professionals must consult those close to the person, including any legally appointed proxy, in line with the relevant capacity legislation, which varies across the UK.
The ReSPECT process has been adopted across many regions of the UK and is used in a range of healthcare settings including hospitals, care homes and community services. Resuscitation Council UK (RCUK) does not collect or hold data on the number of forms completed or how often they have directly influenced clinical decisions. This is primarily due to patient confidentiality.
Data collection and audit are typically managed locally by NHS trusts or health boards. Organisations using ReSPECT are encouraged to monitor how the process supports decision-making, particularly in emergencies and end-of-life care, but such information is not held centrally by RCUK.
Conversations or considerations about resuscitation should never be considered on their own. CPR is only needed if and when the heart stops, and considering what to do in that event should always be considered within the context of thinking about overall goals of care and treatment for that person. That’s why a healthcare professional’s decision to initiate a conversation about goals of treatment should be guided by clinical judgement, the individual’s current health status, and their expressed preferences. It should not be based solely on factors such as age, disability, or a specific risk score. A discussion should never just be about CPR but should always be part of a broader conversation about the person’s goals of treatment and the types of emergency treatment that would be appropriate to support this.
Having a disability in and of itself should not make it any more likely that a conversation about goals of treatment take place. Such conversations can happen for anyone, but are particularly useful for those with health conditions which make them more likely to be at risk of deterioration. It is better to have a conversation while you are able to do so, so for example, if someone has a severe lung condition, or heart failure, a conversation is recommended to take place before an emergency arises, when they might not be able to communicate what is important to them as effectively.
Ethically and legally, anyone with the mental capacity to make decisions about their treatment should be included in conversations about CPR. If a person has limited capacity, they should be supported to participate as much as is appropriate for them. If a person lacks capacity to engage in these conversations or the decision-making process, healthcare professionals should seek input from someone close to them (i.e. a family member), and from their legal proxy if one exists (e.g. a lasting power of attorney for health and welfare in England and Wales), to gain insight into what might matter most to that individual.
