End of Life Planning: DNACPR, ReSPECT & Advance Care Planning

Planning ahead can help make sure someone’s wishes are understood if they become too unwell to make or communicate decisions themselves.

It does not all have to be decided at once.

What matters to the person?

Advance care planning can include discussions about:

• Where someone would prefer to be cared for or die
• Who they want involved in decisions
• Treatments they would or would not want
• What comfort means to them
• Religious, cultural or personal wishes
• Who should speak for them if they cannot communicate

Advance care planning

Advance care planning involves discussing and recording wishes and preferences for future care and treatment.

It can help make sure someone’s voice remains part of decisions even if their health later deteriorates.

Plans can change as circumstances change.

Advance statements

An advance statement can record someone’s wishes, preferences and beliefs about future care.

It is not legally binding, but it can help healthcare professionals and family members understand what matters to the person.

Advance Decision to Refuse Treatment

An Advance Decision to Refuse Treatment, sometimes called an ADRT or living will, can allow someone to specify particular treatments they do not want if they later become unable to make or communicate the decision themselves.

There are legal requirements for an ADRT to be binding in certain circumstances, so professional advice should be sought when making one.

Lasting Power of Attorney for Health and Welfare

A Health and Welfare Lasting Power of Attorney allows someone to appoint a trusted person to make certain health and welfare decisions on their behalf if they are unable to make those decisions themselves.

It is different from simply being someone’s closest relative.

It must be created while the person has the required mental capacity to make it.

DNACPR

DNACPR means Do Not Attempt Cardiopulmonary Resuscitation.

It records a decision that CPR should not be attempted if someone’s heart stops or they stop breathing.

A DNACPR does not mean:

• Care stops
• All treatment stops
• Medication stops
• Food and drink automatically stop
• Personal care stops
• Symptom management stops

ReSPECT

ReSPECT means Recommended Summary Plan for Emergency Care and Treatment.

It is broader than a DNACPR and provides personalised recommendations about emergency treatment and care, based on the person’s wishes and their clinical circumstances.

A ReSPECT plan can include a decision that CPR should not be attempted.

What happens when someone dies?

When someone dies, a healthcare professional will confirm the death and there are legal and practical steps that follow.

The exact process depends on where and how the person dies. A care home, hospice or hospital should guide the family through what happens next. If someone dies at home, the healthcare team will provide instructions.

There can be time to say goodbye. You do not necessarily need to rush into practical arrangements immediately.

After someone dies

There are practical matters that eventually need to be dealt with, including registering the death, arranging a funeral and dealing with medicines, equipment and belongings.

You do not have to do everything immediately.

Bereavement

There is no timetable for grief.

You may experience sadness, anger, relief, guilt, numbness or many different feelings at different times.

There is no correct way to grieve. Time, family, friends, your GP and bereavement services may all provide support.

If you are thinking about wider care and funding decisions, Carentis also provides guidance on NHS Continuing Healthcare, NHS Fast Track funding and care funding.

You may also find our guidance on the Mental Capacity Act helpful when thinking about decision-making and capacity.

If you are wondering whether you did enough

If you have been beside someone through their final days, you may wonder afterwards whether you did enough.

Remember that you didn’t have to make everything perfect. You didn’t have to have all the answers.