Do Not Resuscitate Form in Nunavut

What a DNR Order Actually Is

A Do Not Resuscitate (DNR) order — sometimes called a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order — is a clinical directive issued and signed by a physician or nurse practitioner. It instructs medical staff not to perform CPR, intubation, or mechanical ventilation if a patient's heart stops or they stop breathing.

A DNR is a medical order, not a personal planning document. Your advance directive expresses your wishes; a DNR translates those wishes into a clinical instruction that emergency responders and hospital staff can act on immediately without interpretation.

This distinction matters in Nunavut. Your personal directive is a common-law document that carries evidentiary weight. A DNR is a clinical order that carries direct, binding authority on the treating medical team. They serve different functions and you may need both.

How to Get a DNR in Nunavut

Step 1: Document your wishes. In your personal directive, include a clear, specific statement refusing CPR and mechanical ventilation under defined circumstances. Avoid vague language. "I refuse cardiopulmonary resuscitation if my condition is irreversible" is actionable. "No heroic measures" is not.

Step 2: Discuss with your physician. Bring your directive to your primary care provider at your community health centre or to the Qikiqtani General Hospital in Iqaluit. Walk through your treatment preferences and ask the physician to issue a clinical DNR order based on your documented wishes.

Step 3: The physician issues the order. After confirming your capacity and understanding your wishes, the physician signs a DNR order and enters it into your electronic health record. This is a medical act — the physician must agree that the order is clinically appropriate. A physician is not obligated to issue a DNR that conflicts with their clinical judgment, but a clearly documented, informed refusal of treatment by a capable adult carries significant legal weight.

Step 4: Ensure the order is visible. The DNR must be recorded in a place where it can be found during an emergency. In a hospital setting, it appears in the patient chart. In a community setting, keep a copy at home (the refrigerator method — in a clear sleeve, attached with a magnet) and carry a wallet card noting that a DNR exists.

Pre-Hospital DNR Orders

A pre-hospital DNR is designed to be recognized by paramedics and first responders outside a hospital. In Nunavut, where emergency medical services in remote hamlets may be provided by community health representatives rather than paramedics, ensuring your DNR is accessible at home is particularly important.

The challenge: Nunavut does not have a standardized territorial pre-hospital DNR form the way some provinces do. The clinical order issued by your physician at the health centre serves this purpose, but first responders arriving at your home need to find it quickly. Physical copies in visible locations — on the refrigerator, in a designated medical folder near the front door — are essential.

How a DNR Interacts With Your Personal Directive

Your personal directive and your DNR are complementary:

• The directive records your broad treatment preferences, names your proposed guardian, and covers scenarios beyond cardiac arrest — feeding, hydration, sedation, location of care, cultural accommodations.
• The DNR is a narrow clinical order: do not perform CPR. It does not address other treatment decisions.

If your directive includes a refusal of CPR but no DNR has been issued, clinicians must use their judgment about whether the directive is clear enough to act on in an emergency. A standing DNR order removes that judgment call — it is a direct instruction from one clinician to another.

If a DNR exists but your directive says something different (you changed your mind but did not revoke the DNR), the most recent expression of your wishes takes priority. This is why reviewing both documents together on the same schedule is important.

Can You Change Your Mind?

A DNR can be revoked at any time while you retain capacity. Tell your physician verbally or in writing that you want the order withdrawn. They will update your medical record and the DNR ceases to apply.

If you lose capacity and your court-appointed guardian believes the DNR no longer reflects your wishes, the guardian can request a review. The physician will consider the guardian's request alongside the documented wishes in your personal directive, but the original directive's instructions carry the most weight.

DNR During Medical Travel

When you are flown from Nunavut to a southern hospital, your DNR order needs to travel with you. Ensure:

• A copy is in your carry-on luggage
• Your medical travel escort knows about the order
• The receiving hospital is informed during the transfer of care

The receiving hospital may issue its own DNR order based on your clinical status and documented wishes, replacing the Nunavut order with one that conforms to local clinical protocols. Your personal directive provides the underlying authority for that new order to be issued.

The Nunavut Advance Directive & Living Will Kit includes treatment refusal templates with specific DNR language designed to guide your conversation with your physician and support the issuance of a clinical order.

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