Acute Resuscitation Plan and DNACPR in Queensland: What Families Need to Know

What an Acute Resuscitation Plan Actually Is

An Acute Resuscitation Plan (ARP) is a clinical document — Form SW065 in Queensland Health's system — that records a medical practitioner's orders about what resuscitation and emergency treatment should or shouldn't be provided for a specific patient. It's filled out and authorised by a doctor, not by the patient or family directly.

The ARP functions as a standing medical order. When a patient deteriorates or goes into cardiac arrest, the nursing staff and emergency response team check the ARP before initiating resuscitation. If the ARP says "not for CPR" or "comfort measures only," the clinical team follows that order without needing to call anyone for consent in the moment.

This is fundamentally different from an Advance Health Directive, even though both documents relate to future treatment decisions.

ARP vs Advance Health Directive: Different Documents, Different Authority

The distinction matters because families often confuse these two instruments, and the confusion can lead to outcomes no one intended.

An Advance Health Directive (AHD — Form 4) is a legal document created by the person themselves, under the Powers of Attorney Act 1998. It records the person's own treatment preferences and is legally binding on healthcare providers. The person must have capacity when they sign it, and it requires a doctor's capacity certificate and an independent witness.

An Acute Resuscitation Plan is a medical order created by a treating doctor, often in consultation with the patient (if they have capacity) or their substitute decision-maker. It reflects a clinical assessment of the patient's condition and prognosis. It's clinically binding within the hospital system but doesn't have the same statutory legal force as an AHD.

In practice, the two documents work together. An AHD might say "I refuse mechanical ventilation if I have a terminal illness with no reasonable prospect of recovery and two doctors agree that death is expected within one year." When the patient is admitted to hospital and the treating team reviews the AHD, they create an ARP that translates those preferences into specific clinical orders — "Not for intubation/ventilation. Comfort measures. For symptom management only."

The ARP is the operational document that the bedside team follows in an emergency. The AHD is the legal document that underpins it.

How DNACPR Works in Queensland

DNACPR — Do Not Attempt Cardiopulmonary Resuscitation — is one of the possible directives within an ARP. It means that if the patient's heart stops or they stop breathing, the clinical team will not perform chest compressions, defibrillation, or intubation.

A DNACPR order is not the same as "do nothing." Comfort care continues — pain relief, oxygen, positioning, emotional support. The patient still receives treatment for symptoms. What stops is the specific intervention of attempting to restart the heart or breathing after they've ceased.

In Queensland, a DNACPR order within an ARP should align with the patient's documented wishes (in an AHD or Statement of Choices) or with the decision of their substitute decision-maker. If the patient has a valid AHD that explicitly refuses CPR under their current clinical circumstances, the treating doctor uses that as the basis for the DNACPR order on the ARP.

If there's no AHD and no clear direction from a substitute decision-maker, the treating doctor makes a clinical judgment about whether CPR would be medically appropriate — considering the patient's diagnosis, prognosis, and the likelihood that resuscitation would result in meaningful recovery.

When the ARP and the AHD Conflict

Occasionally, the treating team's clinical assessment leads to an ARP that appears to conflict with the patient's AHD. The most common scenario: a patient's AHD contains general language about not wanting "extraordinary measures," but the treating team interprets their current condition as not meeting the threshold for the AHD's directives to activate (for example, the patient has a serious illness but isn't yet terminal).

Under Queensland law, the AHD's statutory force means its valid, applicable directions take priority. If the AHD clearly and specifically refuses a particular treatment in circumstances that match the patient's current clinical condition, the treating team must follow the AHD — even if they believe the treatment would benefit the patient.

The problem arises with vague or ambiguous AHD language. "No heroic measures" or "no artificial life support" are subjective phrases that clinicians can — and frequently do — interpret differently. When language is ambiguous, doctors tend to treat rather than withhold, to avoid liability. This is the "ambiguity loophole" that makes precise clinical phrasing in an AHD so important.

What Families Should Do

If a family member is in hospital and you're discussing end-of-life treatment options with the medical team:

1. Bring any existing AHD and EPOA documents to the hospital. Even if they've been uploaded to The Viewer, having physical copies on hand speeds up the conversation.

2. Ask to see the ARP once it's completed. You're entitled to understand what clinical orders are in place. If the ARP doesn't reflect the patient's documented wishes, raise the discrepancy with the treating team.

3. Understand your role. If you're the appointed attorney under an EPOA with health powers, you can consent to or refuse treatment on behalf of the patient — but only for decisions not already covered by a valid AHD. If the AHD addresses the specific situation, the AHD's instructions override your authority as attorney.

4. If there's no AHD, the statutory health attorney hierarchy applies: spouse or partner first, then adult children, then parents, then siblings. The doctor consults whoever sits highest on that hierarchy and can be contacted.

For a comprehensive guide to the relationship between ARPs, AHDs, and the EPOA — including clinical phrasing templates that minimise the ambiguity loophole — the Queensland Advance Directive & Living Will Kit covers the entire system.

See more Queensland guides →