Today’s correspondent asks “Is a carer protected under law if they commence CPR in an emergency situation, knowing the person has an NFR order with an advanced care plan?” The answer is, in short, no.

By NFR I infer we mean ‘Not for Resuscitation’.  As for ‘carer’ we do not know whether that means employed as a carer or a person caring for a family member or close friend.

Common law

Remember the common law says that treatment like CPR can be given when there is a necessity to act ‘when it is not practicable to communicate with the assisted person’ and ‘the action taken must be such as a reasonable person would in all the circumstances take, acting in the best interests of the assisted person’ (In Re F [1990] 2 AC 1).  But, continued Lord Goff

On this statement of principle, I wish to observe that officious intervention cannot be justified by the principle of necessity. So intervention cannot be justified … when it is contrary to the known wishes of the assisted person, to the extent that he is capable of rationally forming such a wish.

A person caring for another person not only has personal knowledge of that person, including in this context that they have ‘an NFR order with an advanced care plan’ they also have a duty to provide care that is in the person’s best interests – and that would include respecting and honouring their wishes.  If the carer knows the person has ‘an NFR order with an advanced care plan’ then they know that CPR is either futile, has been determined to be not in the patient’s best interests or is ‘contrary to the known wishes of the assisted person’.  In any of those cases commencing CPR cannot be justified by the principle of necessity.

And would a reasonable person administer CPR to a person they are caring for when they know the person has ‘an NFR order with an advanced care plan’?  My answer to that question would be ‘no’.  The right to consent and refuse consent to treatment is a fundamental principle in law. That right is not lost just because the person needs a carer or because the choice being made is one of life and death.  And if the patient is not capable of making the choice but the medical staff in consultation with relevant family members have determined that the treatment will be futile or not in the patient’s best interests, then the patient has a right not to be subjected to that care even if it would make the carer feel better.

Good Samaritan legislation

In most states there is what is colloquially know as ‘good Samaritan’ legislation – see If we take the NSW provision as an example it says (s 57(1)):

A good samaritan does not incur any personal civil liability in respect of any act or omission done or made by the good samaritan in an emergency when assisting a person who is apparently injured or at risk of being injured.

A good samaritan ‘is a person who, in good faith and without expectation of payment or other reward, comes to the assistance of a person who is apparently injured or at risk of being injured’ (s 56).  If the person provided assistance is the injured person’s carer, and they know that the person has ‘‘an NFR order with an advanced care plan’ then I fail to see how it would be an exercise in ‘good faith’ to administer CPR that you know has been contra-indicated and/or refused.

If the care is paid, then they are paid to assist the person and they are not therefore a ‘good Samaritan’.


If the carer is a family member there is not really anyone to complain to and legal consequences are less likely even if simply because no-one would want to take them to court or the police.  But if the person is employed as a carer, providing CPR contrary to the know NFR order could see the carer civilly or criminally liable (for battery) and at the least putting their job at risk. They are, I hope, employed to provide the care the patient needs and consents to and if an NFR order is in place, then CPR is not indicated care. The family or the patient may rightly complain that the carer is not an appropriate carer if they are not willing to accept the judgement of the patient and/or their treating team as to what is and what is not appropriate care. 

This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.