ReSPECT: supporting emergency care that aligns with what matters most
Why ReSPECT matters
In an emergency, health professionals often need to make swift decisions. But what happens when the person at the centre of that decision-making is too unwell to speak for themselves?
That’s where the Recommended Summary Plan for Emergency Care and Treatment or ReSPECT process plays a vital role.
It helps health and care professionals understand and honour a person's values, preferences, and priorities, especially in urgent or crisis situations, where time is limited and communication might not be possible.
A ReSPECT form records personalised recommendations for treatment in a future emergency. It helps guide decisions, not just based on clinical judgement, but on what matters most to the person, including what treatments they would or wouldn’t want considered.
Many life-sustaining treatments involve risks of causing harm, discomfort and loss of dignity, or the risk of dying in hospital when the person may have wanted to be at home.
Many people choose not to take those risks if the likelihood of benefit from treatment is small. The ReSPECT form can record preferences and recommendations for emergency situations, whatever age or stage of life the person is at.
What is the ReSPECT process?
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It’s not just a form, it’s a process of shared decision-making.
The person, their family or carers (where appropriate), and the healthcare team come together to create a plan that reflects both clinical insight and personal priorities. The result is a written summary - the ReSPECT form - that captures key decisions, including preferences around emergency treatments like hospital admission, intensive care, or Cardiopulmonary Resusitation (CPR).
Crucially, it’s a person-centred conversation. Health professionals bring clinical knowledge. But it’s just as important to listen: What does the person value? What are they worried about? What outcomes would or wouldn’t be acceptable to them?
This process is particularly relevant when someone has a serious health condition, is approaching the end of life, or is at risk of sudden deterioration.
The ReSPECT Form
The ReSPECT form includes:
- Personalised recommendations for emergency treatment
- A decision about whether or not to attempt CPR.
- Space to reference other planning documents, like an Advance Decision to Refuse Treatment (ADRT) – also known as Living Will
- Details of who should be contacted in an emergency
Once completed, the form stays with the person, usually at home, in a clearly accessible place (often in an emergency folder or by the front door). If they are admitted to hospital, the form should travel with them and be included in their clinical notes during their stay. It’s returned to them when they’re discharged.
Who makes the decisions?
The ReSPECT process is about shared decision-making. Health professionals should make every effort to come to a joint agreed plan with the person.
However, it’s important to understand that the ReSPECT form cannot be used by the person to demand treatments that are not likely to benefit them and would not be offered.
The recommendations in the ReSPECT plan are not legally binding, but they are a guide for the emergency healthcare team.
Treatment discussions: What’s covered?
As part of the ReSPECT process, health professionals will discuss a variety of treatment options with the person, and a summary of this will be documented on the form.
There is a special section to document decisions about CPR. CPR is an artificial life support treatment that can, in some circumstances, restart the heart or lungs. However, CPR is rarely successful in people with advanced complex health conditions and it does not work in people who are dying naturally. Where CPR would be inappropriate or potentially harmful, this should be clearly explained, and the recommendation documented.
Importantly, many people choose themselves not to receive CPR once they understand the likely outcomes.
Supporting these conversations with compassion and clarity is a core part of the ReSPECT approach.
When a person lacks capacity to make decisions
The person you are supporting may not be able to make decisions themselves, lacking the ability to understand information and to use it to make informed choices. However, the ReSPECT process can still take place, always with the aim of acting in their best interests.
This is not simply others deciding on their behalf. It involves careful discussion with those who know the person best, such as family, carers, or legal proxies, and thoughtful consideration to ensure the plan is as close to what the individual would have wanted as possible.
Reviewing and updating the plan
ReSPECT is not static. It can and should be reviewed if the person’s condition or circumstances change, or if they express a wish to update their preferences. Regular review is especially important in progressive conditions or after hospital admissions.
Encourage people to revisit their plan when the time feels right. Their preferences may shift, and our understanding of their health may evolve too.
The best care means doing what matters most
ReSPECT is about more than emergency planning. It’s about putting the person at the heart of decision-making, even when they might not be able to speak for themselves.
As a health or care professional, you play a key role in facilitating honest, compassionate, and proactive conversations that help shape care in a way that’s clinically sound and personally meaningful.
It’s about recognising that the best care doesn’t always mean doing more — it means doing what matters most.
More ReSPECT resources
Palliative and End of Life Care Lincolnshire
Lincolnshire’s Palliative and End of Life Care website is a fabulous information resource for health and social care professionals and the public supporting people towards the end of life.
Visit the Lincolnshire Palliative and End of Life Care ReSPECT resources
