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End-of-life conversations are some of the hardest discussions a family can have, and the terminology used in Australia can be quite confusing. Terms such as DNR (Do Not Resuscitate), NFR (Not For Resuscitation), DNAR (Do Not Attempt Resuscitation), ACD (Advance Care Directive), AND (Allow Natural Death), Person Responsible, and Medical Treatment Decision Maker can make it difficult to start a conversation.When someone you love is ageing or facing a serious illness, the question of how they want to be cared for at the end of life can feel impossible to raise. Most families put it off. Then it arrives anyway, often in a crisis, when there is no time to think clearly. Talking about a Do Not Resuscitate order, before it is urgent, gives everyone involved the gift of clarity.
What is DNR? The meaning behind the term
A DNR, or Do Not Resuscitate order, is a medical instruction that cardiopulmonary resuscitation (CPR) should not be attempted if a person’s heart stops or they stop breathing. It does not stop any other care. Pain relief, fluids, antibiotics, oxygen, and comfort measures all continue. The order is specific to one thing: not restarting the heart through chest compressions, electric shocks, or breathing tubes.
In Australia, “DNR” is the everyday term most families use, but it is more of a colloquial label than an official one. In the hospital system, you are more likely to see:
- NFR (Not for Resuscitation): the most common hospital abbreviation used in Australia
- DNAR (Do Not Attempt Resuscitation): preferred in some clinical settings because it reflects that CPR is not always successful
- No CPR: the plain-language form used in some patient documents
- AND (Allow Natural Death): increasingly used because it focuses on the comfort of the dying person rather than what is being withheld
The wording differs. The meaning is the same. A health professional reading any of these in a chart understands they are not to begin CPR.
Worth knowing
A DNR does not mean “do not treat.” Someone with a DNR in place can still receive surgery, antibiotics, dialysis, blood transfusions, or any other treatment they have chosen to accept. It only relates to what happens at the moment of cardiac or respiratory arrest.
DNR, NFR, or Advance Care Directive? Knowing which is which
This is where families often get tangled. In Australia, there are two related but distinct types of documents, and understanding the difference matters.
An Advance Care Directive (ACD) is a legal document you write yourself, while you still have decision-making capacity, that records your preferences for future medical care. It can include a clear instruction not to attempt resuscitation, but it can also cover other treatments, where you want to be cared for, and what matters to you in the final stage of life. It is the foundation document. You do not need a lawyer to make one.
An NFR or DNAR order is a clinical order. It is written by a doctor into a person’s medical record, usually in a hospital or aged care setting, after consultation with the patient or their substitute decision-maker. It directs the health team not to attempt CPR if the person’s heart stops while they are in that facility’s care.
In short:
Document 1
Advance Care Directive
Something you create. A legal document recording your wishes for future medical treatment, including resuscitation, made while you still have capacity.
Document 2
NFR or DNAR order
Something a doctor records. A clinical order written into a patient’s medical chart, based on the patient’s directive or a direct conversation with them or their substitute decision-maker.
The two work together. A well-written Advance Care Directive will usually result in an NFR order being documented in the medical record if and when the person is admitted to the hospital. The directive is the wish. The NFR is the clinical action that follows from it.
Quick tip
If your loved one only has a DNR bracelet or a wallet card, that is not enough on its own. The legally recognised document in Australia is the Advance Care Directive. Make sure one exists, is signed, witnessed for your state, and accessible.
How to get a Do Not Resuscitate order in Australia
Strictly speaking, you do not “get a DNR” the way you might pick up a prescription. What you create is an Advance Care Directive, and the resuscitation decision is part of it. Here is what the process looks like for most families.
Talk to your GP first
Your GP can explain what CPR actually involves at older ages, what the realistic outcomes are for someone with your loved one’s specific health history, and which state forms apply. This one conversation often shifts how families approach the whole topic.
Use your state’s Advance Care Directive form
Each state and territory has its own form, with different witnessing requirements and slightly different legal frameworks. The form used in Victoria is not the same as the one used in NSW or Queensland. Advance Care Planning Australia maintains the current list of state-specific forms.
Have it properly witnessed
Witnessing requirements vary by state. In Victoria, for example, two witnesses are required, one of whom must be a registered medical practitioner. In other states, the witnessing rules are different but equally specific. An invalid signature or a missing witness can render the whole document invalid.
Share copies widely
Your GP, any specialists, the local hospital, your substitute decision-maker, close family, your provider, and anyone else who might be involved. A directive sitting in a desk drawer when the ambulance arrives is of little use.
Upload it to My Health Record
This is the single most useful thing you can do. Once uploaded, treating teams and paramedics with digital access can view the directive in an emergency, regardless of where in Australia your loved one happens to be.
Review it regularly
A directive made ten years ago may no longer reflect what someone wants today. Most families revisit it after any significant change in health, or every couple of years as a routine.
Who can make a medical decision for you in Australia?
If you have decision-making capacity, you decide. Full stop. This is your common-law right, and it cannot be overridden by family members or doctors, even when they disagree with the decision you have made.
The harder question is what happens when someone has lost capacity, through dementia, after a stroke, or while unconscious. Australian law has a clear answer, but the details vary by state.
If a person has lost capacity
Decisions are made by their substitute decision-maker. Depending on the state and how the appointment was made, this person may be called:
- A Medical Treatment Decision Maker (Victoria)
- An Enduring Guardian (NSW, Tasmania)
- An Attorney for personal or health matters (Queensland, ACT)
- A Substitute Decision Maker (South Australia)
- A Guardian (Western Australia, Northern Territory)
A substitute decision-maker can be appointed in two ways:
1. By the person themselves, through a formal document made while they still had capacity. This is the strongest option and gives families the clearest mandate.
2. By default, under state legislation. If no one has been formally appointed, each state has a “person responsible” or default hierarchy, which generally starts with a spouse or partner, then adult children, then parents, then siblings. It is not automatically the next of kin, and the order matters.
A substitute decision-maker carries a serious responsibility. Their role is not to decide what they want for the person, but to decide what the person would have wanted for themselves, based on their values, written instructions, and known wishes.
Important to know
A valid Advance Care Directive cannot be overridden by family members or even by the substitute decision-maker. The directive is the person’s own decision, and the law requires it to be followed. The substitute decision-maker’s job is to honour it, not to replace it.
Do Not Resuscitate orders in aged care facilities
Just Better Care provides support in people’s own homes, not residential aged care facilities. The way a Do Not Resuscitate decision is handled at home differs from how it is handled in a hospital or residential facility, and that difference is worth understanding.
In a hospital or residential aged care facility, a doctor can write an NFR or DNAR order directly into a resident’s medical chart, and clinical staff are trained to act on it. Care at home works differently because the people providing day-to-day support are not always clinically qualified health professionals.
An Advance Care Directive is written to be interpreted by qualified health professionals, and its wording can be clinically nuanced. A directive might state, for example, that resuscitation should not be attempted “if there is no reasonable expectation of recovery to an acceptable quality of life.” Judging whether that condition applies, in the middle of an emergency, is a clinical assessment. It is not something a support worker is qualified to make on the spot.
Important to know
If a person stops breathing or their heart stops while a Just Better Care team member is present, the general guidance is to commence CPR and call 000, even where a Do Not Resuscitate directive is in place. The clinical decision about whether to continue or withhold resuscitation is then made by appropriately qualified professionals, such as paramedics or the person’s treating doctor, who can properly assess the directive and the circumstances.
This does not make an Advance Care Directive any less important. A clearly written, properly witnessed directive, shared with the GP and uploaded to My Health Record, allows paramedics and treating doctors to honour a person’s wishes once they arrive and assess the situation. The directive does its work at the clinical level, which is exactly where these decisions belong.
For families, the practical steps are the same whether care is provided at home or in a facility. Make sure the directive exists, is current, has been shared with the GP and uploaded to My Health Record, and that everyone involved knows where to find it. If your understanding of a loved one’s wishes changes, update the document rather than assuming the file is up to date.
Related reading
Managing work, family, and caring responsibilities: the sandwich generation in Australia →How to start the conversation with your family
This part is rarely about paperwork. It is about giving the people you love permission to honour your wishes when the time comes, without guilt or second-guessing.
A few things tend to help.
Tip 1
Pick the moment, not the crisis
The right time to talk about this is when nothing is urgent. Around the kitchen table, after a routine GP visit, or when a family friend has been through something similar. Not in a hospital waiting room at three in the morning.
Tip 2
Frame it around values, not procedures
Most older Australians find it easier to talk about what matters to them, like dignity, comfort, being at home, being free of pain, than to debate medical interventions in the abstract. Start with the values. The medical decisions follow more easily from there.
Tip 3
Include the substitute decision-maker in the conversation
If someone is going to be making decisions on your behalf, they need to understand what you want and why. A signed document is not enough on its own. The conversation behind it is what gives the document its weight when the moment arrives.
Tip 4
Write it down, then share it
Once your wishes are clear, get them onto a recognised Advance Care Directive form for your state and circulate copies. The most common reason wishes are not followed is not disagreement. It is that nobody could find the document in time.
How Just Better Care supports families through this stage
Locally owned and operated Just Better Care offices provide in-home support to older Australians across the country. While advance care planning conversations sit with your GP, your family, and your loved one’s own voice, the practical support around those conversations is something Just Better Care team members can help with every day.
In-home support that often helps around this stage of life includes:
- Personal care and domestic assistance that keeps daily life steady while bigger decisions are being made
- Transport to GP visits, specialist appointments, and family meetings, so your loved one is not navigating these alone
- Allied health and nursing visits at home, including from registered nurses where required
- Specialised dementia care for people living with dementia and the families supporting them. See our specialised dementia support page.
- End-of-life and palliative support, with familiar Just Better Care team members who know the person and their family
Just Better Care team members do not write directives or give legal advice. What we provide is practical support for the conversation and continuity of care that help a loved one stay safely at home for as long as they want.
In-home aged care from Just Better Care
Locally owned and operated Just Better Care offices across Australia provide personal care, domestic assistance, transport, allied health, and dementia support. Privately funded or through Support at Home.
Explore aged care services →Need support at home while your family navigates these conversations?
Talk to your local Just Better Care office about practical, flexible in-home support that helps older Australians stay safely and comfortably at home.
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