Do Not Resuscitate Northern Ireland: DNACPR, ReSPECT, and Your Rights
There are three documents in Northern Ireland that deal with emergency treatment decisions, and most families mix them up. A DNACPR order, a ReSPECT form, and an Advance Decision to Refuse Treatment all address what happens when a patient can't speak for themselves — but they carry vastly different legal weight, are created by different people, and protect different interests.
Getting them confused can mean placing your trust in a document that a clinical team can override at will.
DNACPR Orders
A Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order is a clinical decision made by a senior doctor. It records that CPR should not be attempted if the patient's heart stops beating or they stop breathing.
Key facts about DNACPR orders:
- They're clinical decisions, not patient directives. A doctor creates a DNACPR based on their clinical judgment that CPR would be unlikely to succeed or would cause more harm than benefit.
- They cover CPR only. A DNACPR says nothing about ventilation, tube feeding, antibiotics, dialysis, or any other treatment. It's a single-intervention decision.
- They're not legally binding in the same way as an ADRT. A DNACPR is a clinical recommendation. If a different clinician arrives — a paramedic, an A&E consultant — they can reassess and may override it based on their own clinical judgment.
- Patients should be consulted but don't have to agree. Clinicians should discuss a DNACPR with the patient (if they have capacity) and their family, but the decision ultimately rests with the medical team.
ReSPECT Forms
The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is being rolled out across parts of Northern Ireland as a broader emergency care planning tool. Unlike a DNACPR order, a ReSPECT form covers a range of emergency treatment decisions, not just CPR.
A ReSPECT form records:
- What matters most to the patient in a medical crisis
- The patient's clinical conditions and current treatment goals
- Specific recommendations for emergency treatments (including but not limited to CPR)
- Whether the focus should be on life-sustaining treatment, comfort care, or something in between
ReSPECT forms are created through a conversation between the patient (or their family, if the patient lacks capacity) and their clinical team. They're valuable clinical tools — but they're not legally binding directives. A ReSPECT form records agreed clinical recommendations that guide emergency teams. It doesn't carry the same legal force as a patient's own advance decision.
Advance Decisions to Refuse Treatment
An ADRT is the only document in this trio that can be legally binding and is controlled entirely by you, the patient. Under Northern Ireland common law:
- You create it while you have mental capacity, not a clinician
- It refuses specific treatments in described circumstances, including life-sustaining interventions
- It's legally binding on any clinician who treats you if it is valid and applicable — not merely a recommendation
- Overriding it carries legal consequences — a clinician who administers treatment in direct contravention of a valid and applicable ADRT faces potential liability for assault
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Where They Overlap and Where They Don't
| Feature | DNACPR | ReSPECT | ADRT |
|---|---|---|---|
| Created by | Clinician | Patient + clinician jointly | Patient |
| Scope | CPR only | Range of emergency treatments | Specific named treatments |
| Legally binding | No — clinical recommendation | No — clinical guidance | Yes — under common law if valid and applicable |
| Covers life-sustaining treatment | CPR only | Can include various treatments | Any treatment you specify |
| Patient control | Consultative | Collaborative | Complete |
The ideal approach in Northern Ireland is to have an ADRT that covers your legally binding refusals alongside a ReSPECT form that guides clinical teams on your broader treatment preferences. The ADRT provides the legal backstop; the ReSPECT form provides the clinical context.
The Practical Concern
If you rely solely on a DNACPR order or a ReSPECT form, your wishes rest on clinical cooperation rather than legal obligation. Most clinical teams are conscientious and will respect documented preferences. But in a fast-moving emergency, when a paramedic arrives at your home and finds you in cardiac arrest, a legally binding ADRT refusing CPR carries a different weight than a clinical recommendation form.
Similarly, if a hospital consultant disagrees with a previous clinician's ReSPECT recommendations, they can revisit the treatment plan. They cannot revisit a valid and applicable ADRT — they're bound by it.
Our Northern Ireland Advance Decision to Refuse Treatment guide explains how these documents interact in practice and provides templates for creating an ADRT that works alongside the clinical care planning system to give you the strongest possible protection.
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