DNACPR & ReSPECT
In this post we’re going to look at two types of special form that specify whether an individual wishes to receive certain types of treatment or not.
DNACPR
DNACPR stands for ‘Do not attempt cardiopulmonary resuscitation (CPR)’. You may have heard it called DNAR for ‘do not attempt resuscitation’ or DNR, for ‘do not resuscitate’. These are older terms, but they all refer to the same procedure. A DNACPR decision is usually made by an individual along with their doctor or healthcare team and is documented on a special form. Everyone who has capacity can refuse CPR if they wish. It means that in the event of an emergency where the person has a cardiopulmonary arrest, or in other words, their heart or breathing stops, it provides a written instruction to guide those present not to attempt CPR. It’s a choice a person can make at any time, for example, when they’re healthy or when they’re approaching the end of their life.
Keep in mind that CPR is considered a medical treatment, and a person has no legal right to treatment that’s clinically inappropriate. For example, this means it’s possible in some circumstances that a doctor might issue a DNACPR order even if a person or their family don’t agree with the decision. For example, if the medical team is convinced that the any negative impact of CPR would outweigh the potential benefit. However best practice will always involve a discussion with the individual and their family to establish their wishes or concerns, and treatment and decisions should be made on an individual and compassionate basis. It’s important those involved understand why and when CPR may not be the right treatment to offer.
There are many reasons why a person might have a recorded DNACPR decision. For example, people with a life-limiting and irreversible condition such as advanced organ failure, or advanced cancer may not want to be subjected to CPR, which is an intensive physical intervention. It may extend the process of dying and with that, potential suffering or pain. It may also deny the person a dignified death, as resuscitation is not guaranteed.
A DNACPR decision is specific to CPR and doesn’t mean a person wouldn’t receive other forms of appropriate care, support and treatment. It’s also not permanent and a person can change their mind at any time and the medical team involved in a person’s care may review the decision at regular intervals with them too. It’s important a change in the decision is carefully documented and communicated so the old DNACPR form is marked as no longer being valid.
ReSPECT
Where DNACPR only addresses one part of emergency treatment, as to whether a person wishes to receive CPR or not, ReSPECT records a wider range of preferences and decisions around emergency treatment. ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process includes DNACPR decisions within an overall emergency treatment plan.
It records a summary of discussions and recommendations when an individual is well enough to make these decisions for a future emergency in which they may be unable to make or express choices. The ReSPECT form then provides health and care professionals responding to that emergency with a summary of recommendations to help them to make immediate decisions about that person’s care and treatment.
ReSPECT is for any adult over 18 but is particularly relevant for certain groups of people.
Individuals with particular health needs that may involve a sudden deterioration in their health.
Individuals with a life limiting condition, such as advanced organ failure, advanced cancer or frailty.
Individuals at risk of sudden events, such as epilepsy or diabetic crisis.
Individuals at foreseeable risk of death or sudden cardiorespiratory arrest.
ReSPECT aims to provide a person-centred approach when considering a broader range of plans for a person’s emergency care and treatment. It helps identify care and treatments that could help an individual achieve their goals for care, as well as treatments they may not want or that may not work for them. For example, this could include decisions around being admitted to hospital or intensive care in an emergency, having intravenous antibiotics for a life-threatening condition, receiving organ support such as dialysis or ventilation and having a blood transfusion or an operation. It could also include whether a person would want to receive hydration and nutrition other than orally, for example either via a tube directly into the stomach or via the nose. Collectively, these decisions are sometimes referred to as ‘ceilings of treatment’. The form also allows an individual to indicate the extent to which they want to prioritise sustaining their life or prioritise being comfortable and pain-free.
The ReSPECT form is kept by the individual and remains valid across any setting, for example at home in the community, a care home or in hospital. It’s good practice for the decisions to be reviewed at regular intervals and recommendations updated as the individual wishes or if their circumstances or condition change. We’ve included some links below where you can access further information.