DNR Orders and Organ Donation in ACT Advance Directives

How Resuscitation Decisions Work in the ACT

A "do not resuscitate" order in the ACT is not something you download from a website and sign at home. Resuscitation decisions sit at the intersection of your legal documents and the clinical team's medical orders — and the two systems do not always communicate cleanly.

The ACT uses the term DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) in clinical settings. A DNACPR is a medical order written by a treating doctor, not a legal instrument signed by the patient. It sits on the clinical file and tells the resuscitation team not to attempt CPR if the patient's heart or breathing stops.

Your Health Direction, by contrast, is a legal instrument under the Medical Treatment (Health Directions) Act 2006. If a treating health professional is aware of a written Health Direction and reasonably believes it complies with the Act and has not been revoked or changed, it is legally binding on clinicians — but a Health Direction alone does not automatically generate a DNACPR order on your hospital chart.

The Gap Between Legal and Clinical

Here is where the practical problem lies. A valid Health Direction refusing CPR is binding on clinicians. But if it is sitting in a drawer at home and not flagged in MyDHR or on the hospital's clinical record, the emergency department team may not know it exists in time to act on it. They may attempt resuscitation by default.

Even when a Health Direction is on file, clinical teams at Canberra Hospital and Calvary Public Hospital typically translate it into an active medical order — a resuscitation plan or DNACPR notation — as part of the admission process. If you have not been admitted and arrive unconscious via ambulance, paramedics will follow their clinical protocols unless they have immediate access to your documented refusal.

The practical lesson: a Health Direction refusing CPR should be uploaded to MyDHR and My Health Record, copies given to your GP, and discussed explicitly with any treating specialist. If you are admitted to hospital, ask the clinical team to confirm that a DNACPR order has been placed on your chart consistent with your Health Direction.

Resuscitation Plans Beyond CPR

A resuscitation plan covers more than just CPR. It may address:

• Mechanical ventilation (intubation and breathing machines)
• Defibrillation (electrical shocks to restart the heart)
• Intravenous vasopressors (drugs to maintain blood pressure)
• Transfer to intensive care
• Artificial nutrition and hydration

Your Health Direction can address any or all of these treatments. The more specific you are, the less discretion the clinical team has to interpret your wishes. A Health Direction that says "I refuse life-sustaining treatment" is less useful than one that lists each intervention individually — because "life-sustaining treatment" is a clinical judgment call, and different doctors may classify the same intervention differently.

The Statement of Choices (the non-binding ACT planning document) is where you record your broader values around quality of life, comfort care, and what "acceptable" recovery looks like to you. Together, the Health Direction and the Statement of Choices give the clinical team both the legally binding refusals and the interpretive context.

Organ Donation and Your Advance Directive

Organ donation is a separate planning process from executing a Health Direction. Record your donation decision through the Australian Organ Donor Register and discuss it with your treating team.

Registering as an organ donor is separate from a Health Direction. A Health Direction refusing CPR or mechanical ventilation can create a practical conflict with an organ-donation plan, so discuss the interaction explicitly with your treating team and the relevant donation service.

If you want to donate organs and also want to refuse long-term life-sustaining treatment, discuss the interaction explicitly with your treating team and the relevant donation service. Do not assume that a Health Direction can create a binding permission for short-term life support: it is binding only for refusals or withdrawals of treatment.

Your Statement of Choices can record your broader values and preferences around organ donation. While the Statement of Choices is not legally binding, it provides guidance to clinicians and your family alongside the relevant donation arrangements.

Putting It Together

The effective approach in the ACT combines three steps:

1. Register your organ donation decision on the Australian Organ Donor Register
2. Execute a Health Direction that specifically lists which interventions you refuse, and discuss with the treating team how any organ-donation plan interacts with those refusals
3. Complete a Statement of Choices that records your values around resuscitation, comfort care, and donation preferences

Upload the Health Direction and Statement of Choices to MyDHR and My Health Record, and discuss your resuscitation and donation wishes with your GP, treating team, and any appointed EPoA attorney.

The ACT Advance Directive & Living Will Kit walks through each of these scenarios with specific guidance on how to draft Health Direction language that works alongside organ donation registration rather than against it.

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