ReSPECT is a personal emergency care plan summary

Advance care plans in the UK vary in style and content, are restricted to specific organisations or localities, and some are many pages long. An effective advance plan to guide immediate decision making in an emergency must be concise, clear, and universally recognised. The recommended summary plan for emergency care and treatment (ReSPECT), which was developed collaboratively by many stakeholders (www.respectprocess.org.uk), aspires to be these things.1 It records emergency care and treatments that should be considered and would be wanted for adults and children,2 as well as treatments not wanted or that would not work. It can apply to any emergency, including those from which full recovery is expected.

For the best outcome from cardiac arrest, cardiopulmonary resuscitation (CPR) must be of high quality. Recommending “partial” CPR would usually be advising suboptimal treatment; national guidance3 defines limited circumstances in which restricted CPR might be appropriate. ReSPECT allows qualification of an adult’s decision about CPR; the different probable causes of cardiorespiratory arrest in children are reflected in a specific option for “modified CPR.” Unlike a valid and applicable advance decision to refuse treatment in England and Wales or an advance directive in Scotland under common law, ReSPECT is not legally binding but must not be ignored in decision making at the time of an emergency.

ReSPECT is the final product of a personal process with several stages: respecting the opportunity to reach shared understanding and discuss realistic choices for future care eases uncertainty; listening shows respect by working at the pace and ability of the patient and those close to them; and shared decision making shows respect for the patient’s wishes, preferences, beliefs, and values in accordance with capacity legislation. ReSPECT is a personal emergency care plan summary that can be used in all care settings.