Do Not Resuscitate Victoria: How DNR Works Under the 2016 Act
How DNR Actually Works in Victoria
Refusing cardiopulmonary resuscitation in Victoria isn't as simple as writing "DNR" on a form. The legal framework involves three distinct layers: your statutory advance care directive, hospital clinical orders, and the treating team's real-time assessment. Understanding how these layers interact determines whether your wishes are actually followed in an emergency.
Under the Medical Treatment Planning and Decisions Act 2016, a valid advance care directive (ACD) containing an instructional directive to refuse CPR is legally binding on health practitioners. But the gap between what's written in your ACD and what happens at 3am in an emergency department is where most families get tripped up.
The Legal Layer: Your Advance Care Directive
To create a legally binding CPR refusal in Victoria, you must include an instructional directive in your ACD that specifically addresses resuscitation. The language matters. Vague statements like "no heroic measures" or "no extraordinary treatment" are difficult for clinicians to interpret under pressure and may be treated as values statements rather than binding instructions.
Effective instructional directive language for CPR refusal:
- "I refuse cardiopulmonary resuscitation (CPR) in all circumstances."
- "I refuse CPR if the treating medical practitioner assesses that I have a terminal or irreversible condition with no reasonable prospect of recovery."
- "I refuse mechanical ventilation except for a trial period not exceeding [number] hours."
Each of these gives the treating team a clear, actionable instruction. The more specific your language, the less room for clinical interpretation.
The Clinical Layer: Goals of Patient Care
Inside Victorian hospitals, day-to-day resuscitation decisions are communicated through Goals of Patient Care (GOPC) forms — internal clinical documents completed by senior medical staff. These aren't statutory instruments signed by the patient. They're clinical communication tools that translate treatment goals into orders the nursing and medical teams follow.
A GOPC form typically classifies a patient into one of several treatment tiers — from "all active treatment including CPR" to "comfort care only." When a patient with an ACD is admitted, the treating team should review the ACD and create a GOPC form that aligns with the patient's documented instructions.
Victorian hospitals also use Acute Resuscitation Plans (ARPs) for patients in acute care, which serve a similar function at the bedside level.
The important thing to understand: your ACD is the legal authority. The GOPC or ARP is how the hospital operationalises that authority. If these documents conflict, the ACD takes precedence.
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The Gap Between Your Document and the Hospital System
Here's where it gets practical. In an acute emergency — a cardiac arrest, a sudden respiratory failure — the clinical team responds based on what's immediately available in the patient record. They check the GOPC or ARP, not a physical copy of your ACD stored in a folder at home.
This means two things:
Your ACD must be on file with the hospital before you need it. If you're admitted for a planned procedure, bring a certified copy. If you have a chronic condition that may lead to emergency admission, ensure your GP has a copy and that it's uploaded to your My Health Record.
The ACD's clinical language must translate cleanly into GOPC categories. If your ACD says "I refuse CPR" in clear, specific terms, the treating team can create a matching GOPC order without ambiguity. If your ACD is vague, the treating team must interpret your intentions — and under time pressure, interpretation often defaults toward active treatment.
What Happens Without an ACD
If you haven't created an advance care directive and you lose capacity, the resuscitation decision falls to the statutory hierarchy under the 2016 Act:
- Your appointed Medical Treatment Decision Maker (if you've made one).
- A VCAT-appointed guardian authorised for medical decisions.
- The nearest available person in the statutory family hierarchy — spouse, then primary carer, then oldest adult child, then oldest parent, then oldest adult sibling.
That family member must then make the CPR decision under enormous time pressure, often without knowing what you would have wanted. An ACD removes that burden entirely.
Organ Donation and Resuscitation
If you wish to donate organs, your ACD's CPR instructions need careful drafting. Organ donation sometimes requires temporary life-sustaining treatment to preserve organs after brain death. You can consent to this specifically in your ACD — for example: "I consent to temporary clinical interventions required solely to facilitate organ and tissue donation, notwithstanding my refusal of CPR for therapeutic purposes."
Without this explicit instruction, a blanket CPR refusal could inadvertently prevent donation.
Making Your Wishes Stick
The distance between writing "DNR" and having that instruction followed in a Victorian hospital comes down to three things: precise clinical language in your ACD, correct statutory execution (two witnesses, one a doctor, all physically present), and copies distributed to the right places before you need them. The Victoria Advance Directive & Living Will Kit includes clinician-approved resuscitation refusal templates and a distribution checklist to close each of those gaps.
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