DNR Ontario: How the Do Not Resuscitate Confirmation Form Actually Works

Why Paramedics Cannot Read Your Power of Attorney

If paramedics arrive at your home and find someone in cardiac arrest, they are legally required to begin full CPR — even if the family hands them a signed Power of Attorney for Personal Care or a handwritten living will. Under Ontario Ministry of Health protocols, first responders cannot interpret legal documents or subjective healthcare directives. They follow one thing and one thing only: the official Do Not Resuscitate Confirmation Form.

This catches almost every family off guard. People assume their carefully prepared POA-PC will protect their wishes in an emergency. It won't — not when 911 is called.

What the DNR-C Form Is

The DNR Confirmation Form (Form 014-4519-45) is a standardized Ministry of Health document that directs paramedics and firefighters not to initiate cardiopulmonary resuscitation. It is not something you can download and fill in yourself. A licensed Ontario physician or nurse practitioner must complete and sign it after a conversation with the patient (if capable) or their substitute decision-maker.

The form is available through the Central Forms Repository or by requesting it directly from the patient's physician. There is no cost for the form itself — it is completed as part of the clinical care relationship.

How the DNR-C Works in Practice

The signed DNR-C form must be physically present and visible in the home. Ontario palliative care guidelines recommend posting it on the front of the refrigerator or in a bright-coloured folder near the main entrance. Paramedics are trained to check these locations first.

If the form is not immediately visible — locked in a filing cabinet, stored at a lawyer's office, or saved as a PDF on someone's phone — it does not exist as far as first responders are concerned. They will begin resuscitation.

The form applies only in community settings (private homes, assisted living, group homes). Inside a hospital or long-term care facility, clinicians follow their own internal medical orders, not the DNR-C.

The EDITH Protocol: Planned Death at Home

For patients who wish to die at home without emergency services being called, Ontario uses the Expected Death in the Home (EDITH) protocol. This is a separate arrangement coordinated between the attending physician, the home care team through Ontario Health atHome, and the family.

Under EDITH, a registered nurse or registered practical nurse is authorized to pronounce death at the home. The physician or nurse practitioner agrees to complete and submit the Medical Certificate of Death to the funeral home within 24 hours. This eliminates the need to call 911, which would otherwise trigger automatic resuscitation attempts and a coroner investigation.

Setting up EDITH requires advance coordination. The attending physician must register the patient with the local home care program, and the nursing team must be briefed on the expected timeline. Families who wait until the final days often find the protocol cannot be arranged quickly enough.

Who Can Request a DNR-C

The patient can request the form directly if they are mentally capable of understanding the decision. If the patient lacks capacity, the request must come from their legally recognized substitute decision-maker — either the attorney named in a valid Power of Attorney for Personal Care or the highest-ranking person in the HCCA's statutory hierarchy (spouse, then adult children, then siblings, and so on down to the Office of the Public Guardian and Trustee).

The physician is not obligated to complete the form simply because someone requests it. The conversation involves a clinical assessment of the patient's condition and prognosis, and the physician must be satisfied that the decision reflects informed consent.

Common Mistakes Families Make

The most expensive mistake is assuming that any advance directive will stop paramedics. It won't. Ontario operates under a "resuscitate unless proven otherwise" framework for pre-hospital care, and the proof must be the specific Ministry of Health form.

The second mistake is obtaining the DNR-C but storing it improperly. A form in a safety deposit box or in a lawyer's vault does nothing during a 3 AM cardiac arrest. The original (or a clearly legible copy — practices vary by local service) must be at the patient's bedside or posted prominently in the home.

The third mistake is confusing facility-level DNR orders with the community DNR-C. A hospital's internal "no CPR" notation on a patient chart does not travel with the patient when they are discharged home. A new DNR-C must be completed for the community setting.

How to Get the Process Started

Start with the patient's family physician or the palliative care team. Ask specifically about the DNR Confirmation Form and, if appropriate, the EDITH protocol. Both conversations should happen well before a crisis — the paperwork and coordination take time, and physicians may need a formal consultation before completing the form.

Our Ontario Advance Directive & Living Will Kit walks through the entire DNR-C and EDITH setup process step by step, including a placement protocol checklist and scripts for initiating the conversation with your physician. It also covers how the DNR-C fits alongside your Power of Attorney for Personal Care and the broader advance care planning framework under the Health Care Consent Act.

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