ReSPECT Form and DNACPR: What Care Teams Need to Know

A ReSPECT form is a personal plan that records recommendations for someone's care in a future emergency, when they can't make or express choices themselves. It comes from conversations between the person, the people close to them and their health professionals. It includes a recommendation about CPR, but covers far more. A DNACPR decision is about CPR only. Neither is legally binding.

What ReSPECT stands for and who it's for

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It launched in 2016 and is led by Resuscitation Council UK, working with royal colleges, charities and regulators. It can be for anyone, but it's especially relevant for people with complex health needs, people nearing the end of their lives and people at risk of sudden deterioration or cardiac arrest.

A ReSPECT form records:

• the person's current health and what matters most to them
• the focus of their care, which can balance extending life against comfort
• treatments that should be considered, and ones that wouldn't work or that they wouldn't want
• a recommendation about whether CPR should be attempted
• emergency contacts, and who took part in the conversation

The plan belongs to the person and stays with them, including when they go to hospital.

ReSPECT form vs DNACPR: what's the difference?

A DNACPR (do not attempt cardiopulmonary resuscitation) decision means that if the person's heart or breathing stops, the healthcare team won't try to restart it. You may see it called DNAR or DNR. The NHS is clear that DNACPR is about CPR only: the person keeps all other appropriate care.

ReSPECT puts the CPR recommendation inside a whole plan for emergency care, and that recommendation can be for CPR or against it. The NHS lists ReSPECT as one of the forms that can record a DNACPR decision.

Neither form is legally binding, and neither is an advance decision to refuse treatment. Resuscitation Council UK says clinicians should have valid reasons for not following a ReSPECT recommendation. In England and Wales, a legally binding refusal of CPR needs an advance decision under the Mental Capacity Act 2005: in writing, signed, witnessed, and stating it applies even if the person's life is at risk.

Who makes and records the decisions

Any clinician involved in the person's care can lead a ReSPECT conversation. It doesn't have to be a GP or hospital doctor, and a nurse may lead it. The clinician signs the form. The person, their legal proxy or family can sign too, but don't have to. For DNACPR, the NHS says a doctor can decide CPR shouldn't be attempted even if the person disagrees, but must consult them and explain why.

Care staff don't make these decisions. But your team often knows the person best: what they've said about dying, who matters to them, how they communicate. Make sure that reaches the clinician.

When the person lacks capacity

In England and Wales, the Mental Capacity Act 2005 applies. A person is assumed to have capacity unless it's shown otherwise. If someone lacks capacity to take part, the NHS describes this order:

• the doctor checks for a valid advance decision refusing CPR
• then for a lasting power of attorney for health and welfare covering life-sustaining treatment. The attorney can decide about CPR in the person's best interests, but can't insist on it
• if neither exists, a senior doctor makes a best interests decision after consulting others

The Act says the decision-maker must take into account, where practicable and appropriate, the views of anyone engaged in caring for the person. That can include your staff. For ReSPECT, the conversation must then take place with the person's family or legal proxy.

Scotland uses the Adults with Incapacity (Scotland) Act 2000 and has its own national CPR policy. Northern Ireland has separate law again. If you run services in more than one nation, check which applies.

The rights of the person and their family

• To be involved, and never pressured into a ReSPECT conversation they don't want.
• To ask for a second opinion or a review if they disagree.
• To refuse CPR, and in England and Wales to make that refusal binding with an advance decision.
• Not to demand treatment that won't work. In the NHS's words, nobody has the right to demand CPR.
• For families: to be consulted when the person lacks capacity, and to ask for a review.

What your staff should do in an emergency

This is what staff worry about on a night shift. Keep it simple and write it into your policy.

1. Know where the forms are. Anyone on shift should find the current form quickly.
2. Call for help as your policy says. A recommendation against CPR doesn't mean don't call. Tell the ambulance crew about the form and give it to them.
3. Follow the recommendation. Where a valid plan says CPR shouldn't be attempted, it isn't. Comfort, dignity and other care carry on.
4. If there's no form, or you're unsure it applies, start CPR and follow your policy. National guidance sets an initial presumption in favour of CPR when no decision is recorded. The exception is where there are clear signs the person died some time ago, such as rigor mortis, so make sure your policy says what staff do then. Care staff should follow their basic life support training.
5. Send the plan with the person to hospital, and check it's reviewed when they return.

When someone dies as expected, follow your expected death procedure, including who verifies the death. Registered nurses can train for that on our verification of expected death course.

Why CQC is concerned about blanket decisions

In 2020 the Department of Health and Social Care asked CQC to review DNACPR decisions during the pandemic. CQC's March 2021 report, Protect, respect, connect, heard from over 750 people. It heard reports of "blanket" DNACPR decisions applied to groups rather than to each person's circumstances, people unaware a decision had been made about them, and records too poor to show people had been involved.

CQC regulates in England, but the lesson holds everywhere:

• never accept a DNACPR applied to everyone in a service, or to everyone of a certain age, diagnosis or disability
• check on admission that each form is about that person, signed and shows who was involved

ReSPECT isn't used everywhere

Adoption varies by area. Resuscitation Council UK's adoption page, updated in May 2026, shows many parts of England and Scotland using ReSPECT, but not all. Much of London uses the Universal Care Plan, Scottish adoption is decided by health board, Wales has its own All Wales DNACPR policy, and Northern Ireland is working towards adoption. Find out what your local NHS uses, and make sure staff recognise forms from other areas when someone moves in.

How Kasorb can help

Our end of life care training helps care staff support people and their families in the last months and days of life. In half a day, on site or live online, it covers communication in preparation for the end of life, the physical, psychological, spiritual and social needs of the person and their family, national policy and guidance, local initiatives such as end of life registers, and advance care planning. It's one flat rate for the group, two sessions can run in one day, and certificates are emailed the next day. For a full day on symptoms and supporting families, see our palliative care training.

This guide summarises the law and guidance; it isn't legal advice.

FAQs

Is a ReSPECT form the same as a DNACPR?

No. A DNACPR decision covers CPR only. A ReSPECT form is a wider emergency care plan that records what matters to the person, which treatments to consider, and a recommendation about CPR, which can be for or against it.

Is a ReSPECT form legally binding?

No. It records recommendations to guide professionals in an emergency, and clinicians should have valid reasons for not following them. In England and Wales, a legally binding refusal needs an advance decision under the Mental Capacity Act 2005.

Can a family member overrule a DNACPR?

Not usually. Families should be consulted when the person lacks capacity, and can ask for a second opinion or review. In England and Wales, a health and welfare attorney whose LPA covers life-sustaining treatment can decide about CPR in the person's best interests, but nobody can insist on CPR.

Who can fill in a ReSPECT form?

Any clinician involved in the person's care can lead the conversation and complete the form. It doesn't have to be a GP or hospital doctor. The clinician signs it, and the person, their legal proxy or family can sign too if they wish.

Does DNACPR mean no other treatment?

No. A DNACPR decision is about CPR only. The person should still receive all other appropriate care and treatment. If staff are unsure what a plan covers, they should ask the responsible clinician.