Do Not Resuscitate NSW: DNR Forms, Resuscitation Plans, and Your Rights

There Is No Standalone DNR Form in NSW

NSW does not have a standalone "do not resuscitate" form that patients fill out and carry with them. Instead, resuscitation decisions are documented through two mechanisms that work together: your advance care directive (a common-law document you write) and a hospital resuscitation plan (a clinical order a senior doctor writes based on your directive and your current medical condition).

The distinction matters. Your advance care directive records your treatment preferences before you are admitted to hospital. The resuscitation plan is a clinical translation of those preferences into actionable medical orders that nursing and emergency staff can follow in real time. You do not fill out the resuscitation plan yourself — a treating doctor creates it after reviewing your directive and assessing your clinical situation.

How Resuscitation Plans Work Under PD2014_030

NSW Health Policy Directive PD2014_030 ("Using Resuscitation Plans in End of Life Decisions") describes the standards and principles for appropriate use of adult and paediatric resuscitation plans by NSW public health organisations. A resuscitation plan is a medically authorised order to use or withhold resuscitation measures and should align with any existing advance care directive.

The resuscitation plan specifies the level of clinical intervention the patient will receive. The categories typically range from full active treatment (including CPR, intubation, and ICU admission) down to comfort care only (symptom management without life-prolonging interventions). The plan is recorded in the patient's electronic medical record and is immediately accessible to ward staff, emergency teams, and the Medical Emergency Team (MET).

If a patient presents to hospital with a valid advance care directive that clearly refuses CPR, the treating doctor translates that refusal into the relevant NSW Resuscitation Plan entry. This gives clinical staff a direct, medically authorised order to follow while the directive remains available for context.

Writing CPR Preferences in Your Advance Care Directive

Because the resuscitation plan depends on your directive, the quality of your CPR instructions determines whether clinicians follow your wishes or default to full intervention. The test under NSW common law is whether your instructions are clear, specific, and applicable to the clinical situation.

Effective language: "I refuse cardiopulmonary resuscitation if my treating medical team assesses that the likely outcome of CPR is survival with severe neurological impairment, or if I am in the terminal phase of an irreversible illness."

Ineffective language: "No heroic measures" or "I want to die with dignity." These phrases do not tell the resuscitation team whether to start CPR in a specific scenario, so they will default to full intervention while seeking clarification.

If you have a specific cardiac or respiratory condition, discuss the realistic outcomes of CPR with your cardiologist or respiratory specialist. The survival-to-discharge rate after in-hospital cardiac arrest in Australia is roughly 25%, but outcomes vary dramatically based on the underlying condition, the patient's age, and whether the arrest is witnessed. Your doctor can help you understand what CPR would actually mean for your body and write instructions that reflect that reality.

DNACPR and the Difference Between CPR and Other Interventions

A NSW Resuscitation Plan can specify that cardiopulmonary resuscitation is not to be attempted. That direction does not automatically mean you refuse all other treatment — you might still want antibiotics, IV fluids, or pain management.

This is why your advance care directive should address each intervention category separately rather than using a catch-all "do not resuscitate" instruction. You might refuse CPR but consent to short-term mechanical ventilation for a reversible condition. Or you might refuse both CPR and ventilation but want full palliative symptom management. Spelling out each category prevents clinicians from making assumptions about what your "DNR" directive covers.

Ambulance and Out-of-Hospital Settings

NSW Ambulance paramedics assess the patient and can consider valid treatment directives, including an advance care directive, a resuscitation plan, and input from an Enduring Guardian. They do not know your medical history before arrival, so give them any relevant paperwork and contact details when they arrive.

If you have a strong preference against resuscitation, discuss a NSW Health Resuscitation Plan with your treating team and carry an emergency wallet card referencing your advance care directive and your My Health Record. Some aged care facilities use standardised "goals of care" documents — ask your facility whether it uses this system.

Where to Go From Here

A well-drafted advance care directive that addresses CPR, ventilation, artificial nutrition, and other intervention categories is the foundation. Pairing it with an enduring guardian appointment ensures that a trusted person can make decisions about treatments your directive does not cover. The NSW Advance Directive & Living Will Kit includes clinical translation worksheets that help you write treatment-specific instructions rather than vague preferences.

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