DNACPR and ReSPECT Form Scotland: What They Are and How They Work

Clinical Orders, Not Legal Documents

A DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) and a ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form are both part of the NHS Scotland clinical framework. They look similar to an advance directive — both deal with end-of-life treatment preferences — but they operate in a fundamentally different way.

An advance directive is your document. You write it, you sign it, and it represents your legally binding treatment refusals under Scots common law.

A DNACPR or ReSPECT form is the clinician's document. It records a medical recommendation about whether CPR and other emergency treatments are appropriate for you, based on your clinical condition and (ideally) your wishes. It is clinical guidance, not a legal directive.

Understanding this distinction matters because it changes who controls the decision and what happens when there is a disagreement.

What a DNACPR Form Covers

A DNACPR form records a clinical decision that cardiopulmonary resuscitation should not be attempted if the patient's heart stops or they stop breathing. It covers CPR specifically — chest compressions, defibrillation, and rescue breathing — and nothing else.

A DNACPR form does not:

• Refuse other treatments (antibiotics, surgery, admission to intensive care)
• Replace an advance directive
• Remove your right to any other form of medical care
• Mean that you will receive less attention or lower-quality care

The form can be initiated by the clinical team based on their assessment that CPR would not be successful, or it can be requested by the patient. In Scotland, doctors are not obligated to offer CPR if they believe it would be futile — this is a clinical judgment, not a patient choice. But they should discuss the decision with the patient or their welfare attorney and document the conversation.

What a ReSPECT Form Covers

ReSPECT is broader than DNACPR. It is a summary plan for emergency care that records:

• Whether CPR should be attempted
• The overall goal of treatment (life-sustaining treatment at all costs, treatment with a focus on comfort, or comfort-focused care only)
• Specific interventions the patient does or does not want
• Who has been consulted in making these decisions

ReSPECT forms are used across much of the UK, but in Scotland they integrate with the NHS Key Information Summary (KIS) system and the National Digital Platform (NDP). When a ReSPECT form is completed, its contents are logged on the KIS so that the Scottish Ambulance Service and NHS 24 can access them immediately during an emergency.

How They Interact with an Advance Directive

An advance directive and a DNACPR/ReSPECT form are complementary, not interchangeable.

An advance directive stands alone. It does not require any clinical input, and a doctor refusing to complete a DNACPR form does not affect the legal validity of your advance directive. If your directive clearly refuses CPR and the clinical scenario matches, the directive is legally binding whether or not a DNACPR form exists.

But a DNACPR/ReSPECT form is what emergency teams check first. In practice, paramedics arriving at a cardiac arrest do not have time to locate and interpret a multi-page advance directive. They check the KIS. If a DNACPR or ReSPECT entry is on the KIS, they can act on it within seconds. If there is no KIS entry, they will default to attempting resuscitation.

This is why having both is important. The advance directive provides the legal authority; the DNACPR/ReSPECT form provides the clinical shorthand that emergency teams can act on immediately.

How to Get a DNACPR or ReSPECT Form in Scotland

You cannot complete a DNACPR or ReSPECT form yourself. These are clinical documents that require a doctor's involvement.

1. Raise it with your GP — tell them you want to discuss whether a DNACPR or ReSPECT form is appropriate given your medical history and advance directive
2. Bring your advance directive — showing the GP your documented treatment refusals makes the clinical conversation concrete rather than abstract
3. Ask about KIS registration — once the form is completed, confirm that its contents have been uploaded to the KIS database so emergency services can access them
4. Request a copy — you should have a copy of any DNACPR or ReSPECT form that has been completed for you

If your GP declines to complete a DNACPR form because they believe CPR could be clinically appropriate, that does not weaken your advance directive. The directive remains legally binding on its own terms. But it does mean there will be no DNACPR entry on the KIS for emergency teams to find quickly.

Can a Family Member Challenge a DNACPR?

Family members sometimes object to DNACPR decisions, particularly when they feel the decision was made without adequate consultation. In Scotland, the clinical team is expected to discuss the decision with the patient or their welfare attorney, but the final decision rests with the senior clinician responsible for care.

If a family member objects and the patient has a valid advance directive that supports the DNACPR decision, the directive provides authoritative evidence of the patient's own wishes — removing the dispute from the family-versus-doctor dynamic and grounding it in the patient's documented preferences.

The Scotland Advance Directive Planning Kit includes the clinical verification worksheets that help align your advance directive with DNACPR and ReSPECT processes, plus the GP letter template for ensuring everything reaches the KIS database.

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