ReSPECT Process NHS
What ReSPECT Actually Is
The Recommended Summary Plan for Emergency Care and Treatment — ReSPECT — is a clinical communication tool used across NHS trusts in England. It records emergency treatment recommendations that emerge from discussions between you, your family, and your clinical team.
The form summarises what interventions should or should not be attempted if you deteriorate rapidly — whether CPR should be attempted, whether you should be admitted to intensive care, whether the focus should shift to comfort care. Paramedics, A&E staff, and ward teams use it as a quick reference during emergencies.
What it is not: a legal document. ReSPECT is clinical guidance, not a statutory instrument. A doctor can override it if their clinical judgement at the moment of treatment differs from what the form recommends.
How It Differs from a DNACPR
A DNACPR — Do Not Attempt Cardiopulmonary Resuscitation — is a specific clinical recommendation that CPR should not be attempted if your heart stops or you stop breathing. Like ReSPECT, it is not legally binding.
ReSPECT is broader. It covers a wider range of emergency interventions beyond CPR — including decisions about ventilation, hospital transfer, and the overall goals of care. Many NHS trusts now use ReSPECT as the overarching emergency plan, with the CPR decision embedded within it as one component.
Both DNACPR and ReSPECT are completed by clinicians, usually in consultation with the patient and family. But neither is a patient's own legal instruction. They are clinical records that summarise recommendations.
The Legally Binding Alternative
If you want your refusal of CPR — or any other life-sustaining treatment — to be legally binding on the medical team, that refusal must be documented in a valid Advance Decision to Refuse Treatment (ADRT) under the Mental Capacity Act 2005.
The ADRT must:
- Be in writing
- Name CPR (or the specific treatment) explicitly
- Define the clinical circumstances under which you refuse it
- Include the statement that the refusal applies "even if my life is at risk as a result"
- Be signed and witnessed
A valid ADRT overrides both ReSPECT recommendations and DNACPR orders. It is a binding legal instruction, not a clinical suggestion.
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Can a Hospital Put a DNACPR on Without Your Consent?
This is one of the most distressing situations families encounter, and the legal position is nuanced.
A clinician can place a DNACPR on a patient's file without the patient's explicit consent if, in the clinician's professional judgement, CPR would be clinically futile — meaning it has no realistic chance of restarting the heart and restoring circulation. In that scenario, the DNACPR records a clinical assessment, not a patient preference.
However, when CPR might work but the question is whether the patient would want it attempted, the clinical team should discuss the decision with the patient (if they have capacity) or their registered Health and Welfare attorney (if they do not).
Families who want certainty should not rely on DNACPR orders alone. An ADRT that explicitly refuses CPR under defined clinical conditions gives the refusal statutory force. Conversely, if the patient wants CPR attempted in all circumstances, that preference should be recorded in an Advance Statement — though clinicians are not bound by it if they judge CPR to be futile.
Making ReSPECT and an ADRT Work Together
ReSPECT and an ADRT can coexist. The practical approach:
- Use an ADRT for your firm legal refusals — the treatments you definitely do not want, under any circumstances
- Use the ReSPECT process to communicate broader preferences — your overall goals of care, how much intervention you want in various scenarios, whether you prefer to die at home
- Ensure your GP and hospital teams are aware of both documents and that they do not contradict each other
The England ADRT Guide covers the full legal distinction between ReSPECT, DNACPR, Advance Statements, and ADRTs, with specific drafting guidance for making your CPR refusal legally binding and a storage protocol to ensure emergency teams can access the right document at the right time.
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