Understanding DNACPR, ReSPECT, ADRT and Wishes & Preferences in Health Care Planning (UK)
When planning for future medical treatment—especially in situations where you might not be able to make decisions for yourself—it’s important to understand the different types of documents that can help guide your care. In the UK, there are several options available, each serving a slightly different purpose. This blog post will help you understand the differences between a DNACPR, a ReSPECT form, an ADRT, and a Wishes and Preferences document.
1. DNACPR (Do Not Attempt Cardiopulmonary Resuscitation)
A DNACPR is a clinical decision made by a healthcare professional that CPR (cardiopulmonary resuscitation) should not be attempted if a person’s heart or breathing stops. CPR can be invasive and is not always appropriate, especially for people with serious illness or frailty, where it may do more harm than good.
- Legal status: Not legally binding, but it is a medical decision recorded to guide emergency care.
- Who completes it? A doctor, usually in consultation with the patient and/or their family.
- Purpose: To avoid unnecessary or harmful attempts at resuscitation.
- Scope: Applies only to CPR – it does not cover other treatments or interventions.
2. ReSPECT Form (Recommended Summary Plan for Emergency Care and Treatment)
The ReSPECT process creates a personalised plan for a person’s clinical care in a future emergency when they might not be able to make or express choices. The form summarises what treatments would or would not be wanted, as well as the person’s values and priorities.
- Legal status: Not legally binding, but considered a valuable guide for healthcare professionals.
- Who completes it? Typically a collaborative process between the person and healthcare professionals.
- Purpose: To provide a broader picture than DNACPR, including preferences about a range of emergency treatments.
- Scope: Covers CPR and other treatments like hospital admission, ventilation, or intensive care.
3. ADRT (Advance Decision to Refuse Treatment)
An ADRT (also known as a living will) is a legally binding document in which a person can refuse specific medical treatments in the future, including life-sustaining treatment, under the Mental Capacity Act 2005.
- Legal status: Legally binding if it meets specific criteria.
- Who completes it? The individual, while they have mental capacity.
- Purpose: To ensure that specific treatments are refused even if the person loses capacity in the future.
- Scope: Can include any treatment, provided the refusal is clear and applicable to the situation.
Note: To refuse life-sustaining treatment, the ADRT must be in writing, signed, witnessed, and clearly state that the decision applies even if life is at risk.
4. Wishes and Preferences Document
This is an informal statement where a person can express their values, preferences, and beliefs about care and treatment. It might include things like wanting to stay at home rather than go to hospital, preferences around food, or spiritual needs.
- Legal status: Not legally binding, but must be considered under the Mental Capacity Act 2005 when making best interest decisions.
- Who completes it? The individual, possibly with help from family or care professionals.
- Purpose: To help guide care that aligns with the person’s values.
- Scope: Broad and holistic – not limited to medical treatments.
Key Differences at a Glance
| Document | Legally Binding | Covers CPR | Covers Other Treatments | Completed By |
|---|---|---|---|---|
| DNACPR | No | ✔️ | ❌ | Doctor/Healthcare Team |
| ReSPECT | No | ✔️ | ✔️ | Collaborative – Person + Professionals |
| ADRT | ✔️ | ✔️ (if specified) | ✔️ | Individual |
| Wishes & Preferences | No | ❌ | ✔️ | Individual |
Final Thoughts
Planning ahead for your healthcare is an empowering and responsible step, especially if you’re living with a serious illness, or simply want to make sure your future care reflects your values. Each of these documents plays a role in ensuring that your voice is heard—even when you may not be able to speak for yourself.
If you’re unsure where to begin, speak to your GP, a palliative care professional, or an organisation like Compassion in Dying or Advance Care Planning services in your area.
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