Catholic Medical Quarterly Volume 72 (4) November 2022
Correspondence
The Use and Misuse of the ReSPECT Form
ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. It was formulated by the UK Resuscitation Council (1) and is now in its third version. It is intended to represent the wishes of the patient in an emergency or for future care and treatment. It is signed by the doctor after discussion with the patient who has capacity, but is not legally binding. In as much as it is based on accurate, unhurried and a realistic understanding by the patient , it can enhance autonomy.
It is, though, a form of advance directive and subject to the limitations of advance directives especially if it is long standing and the patient`s views have changed. It puts before the patient the options "Prioritise sustaining life, even at the expense of some comfort", and "Prioritise comfort, even at the expense of sustaining life". In fact, often the best treatment may lie between these two extremes but there is a risk that it may be seen as one or the other. It is completed and interpreted by the doctor. There is a tick box at the bottom of the form concerning cardio-pulmonary resuscitation which includes "Not recommended".
Since Christian Erikson had a cardiac arrest on the football pitch before thousands, awareness of cardiac arrest has increased . He had CPR on the pitch and has returned to professional football two years later. Many persons have now been trained in CPR and defibrillators are more available. I myself had a patient who had a cardiac arrest playing football. The referee applied CPR and after defibrillation he made a full recovery a year later. There needs to be a discussion and the form completed carefully. There is no place for a decision which is not made by a competent patient, or if that is not possible, by a health attorney or legal guardian, nor should the form be filed away without the patient or family knowing. This has been the subject of a High Court decision (2) It is not just best practise but a legal requirement.
In the case of where a patient lacks capacity should they suffer dementia for example, a health attorney should be consulted. Next of kin does not have legal standing . Where there is learning disability , autism , or psychosis a health attorney or court appointed guardian may be needed. The mortality may be increased where these conditions arise as shown by the ReDer (Learning Disabilities Review) .
In summary, the ReSPECT form if accompanied by unhurried, thoughtful and accurate understanding of the actual condition that has arisen can empower patients. When the decision is about cardio pulmonary resuscitation a higher legal requirement is required. The tick box approach is deleterious to to proper medical care and open to challenge. All lives are of equal value .
Dr Tony Cole J P FRCPEdin. FRCPCH,
Chairman, Medical Ethics
Alliance
References;
- Resuscitation Council (UK) / Version 3 - 10-10-19
- Tracy.R (on application) Cambridge University N H S Foundation Trust (2014) EWCACiv 822