Advance Directive / Do Not Resuscitate Order (Nigeria)

An Advance Directive / Do Not Resuscitate Order in Nigeria records a person's instructions for their future medical care should they lose capacity to decide.

The legal foundation for advance medical decision-making in Nigeria is primarily established by the National Health Act 2014, which is the principal federal statute governing healthcare rights and obligations in Nigeria. Section 23 of the National Health Act 2014 explicitly gives a healthcare user (patient) the right to refuse medical treatment, including treatment that may prolong life, provided the patient is competent and has been informed of the consequences of their refusal. This provision gives a competent adult the same right to refuse as would be exercised if the patient were fully conscious at the relevant time.

The Medical and Dental Council of Nigeria (MDCN), which regulates medical practitioners under the Medical and Dental Practitioners Act Cap M8 LFN 2004, has issued guidelines that require practitioners to treat their patients with respect for autonomy, informed consent, and individual dignity. These ethical requirements support respecting advance directives as an extension of the informed consent process to future incapacity.

Nigeria does not yet have dedicated advance directive legislation. The National Health Act 2014 is the primary statutory hook. Several Nigerian states — including Lagos, Abuja (FCT), and Rivers — have state-level health laws that may interact with advance directive practice. In practical terms, advance directives are most commonly used in tertiary hospital settings: the Lagos University Teaching Hospital (LUTH), the National Hospital Abuja, the University of Nigeria Teaching Hospital (UNTH) Enugu, and the University College Hospital (UCH) Ibadan all handle end-of-life care planning for patients with terminal diagnoses.

A DNR order (Do Not Resuscitate), as a specific type of advance directive, instructs healthcare providers not to initiate cardiopulmonary resuscitation (CPR) if the patient's heart or breathing stops. In Nigerian intensive care units and oncology wards, DNR discussions and documentation are an increasing part of palliative care practice, guided by the MDCN's ethical framework and the growing influence of the Nigerian palliative care community.

The legal framework governing the Advance Directive / Do Not Resuscitate Order (Nigeria) rests on the National Health Act 2014 (Section 23 — right to refuse treatment), the Medical and Dental Practitioners Act Cap M8 LFN 2004 (which authorises the Medical and Dental Council of Nigeria (MDCN) to set ethical standards), and the Constitution of the Federal Republic of Nigeria 1999 (Section 34 — right to dignity of the human person; Section 38 — freedom of religion). The National Health Act 2014 (Section 26) imposes duties on health establishments to respect patient rights. The Lagos State Health Sector Reform Law 2006 and the Anambra State Health Law apply in their respective states alongside federal provisions. The Evidence Act 2011 (Sections 83–88) governs the admissibility of the directive as a document in State High Court or Federal High Court proceedings. The Nigeria Data Protection Regulation (NDPR) 2019 (Section 2.3) and the Nigeria Data Protection Commission (NDPC) govern handling of sensitive health data in medical records. The National Insurance Commission (NAICOM) regulations apply to health insurance implications of DNR orders. Forms-legal.com provides this template as a starting point for Nigeria-compliant documentation.

A Nigeria Advance Directive and DNR declaration is needed whenever an adult wishes to record their medical treatment preferences before incapacity occurs.

When a patient at a Lagos or Abuja hospital receives a diagnosis of terminal cancer — such as advanced hepatocellular carcinoma or stage IV colorectal cancer — the treating oncologist may initiate a discussion about the patient's wishes for end-of-life care, including whether the patient wishes to be resuscitated in the event of cardiac arrest. An advance directive recording the patient's informed decision allows those wishes to be respected even after the patient can no longer communicate.

When an elderly person in Nigeria has multiple chronic conditions — such as end-stage heart failure, advanced Parkinson's disease, or severe dementia — and wishes to avoid aggressive life-prolonging intervention, an advance directive records the decision to focus on comfort care rather than curative treatment, guiding both the treating medical team and the family.

When a person of any age with a strongly held religious faith wishes to confirm that their religious convictions about medical treatment — including refusal of blood transfusions, refusal of certain surgical interventions, or preference for faith-based healing — are respected if they lose capacity, an advance directive documents those convictions for the medical team.

When an adult executes a Will or a Power of Attorney and wishes to complete their suite of personal planning documents, an advance directive or healthcare proxy designation is a natural complement — confirming that medical, financial, and estate decisions are all documented.

When a person is about to undergo a major surgical procedure at a Nigerian hospital and wishes to record their wishes about resuscitation and life support in the event of surgical complications, an advance directive filed with the hospital before surgery provides clear guidance to the surgical team.

Nigerians should prepare an Advance Directive / Do Not Resuscitate Order proactively, ideally alongside a Will under the Wills Act Cap W12 LFN 2004 or Wills Law of the applicable state, and a General Power of Attorney under the Powers of Attorney Act Cap P16 LFN 2004. The National Health Act 2014 (Section 23) is the primary statutory authority for treatment refusal. The MDCN Code of Medical Ethics requires practitioners at teaching hospitals such as Lagos University Teaching Hospital (LUTH), National Hospital Abuja, and University College Hospital (UCH) Ibadan to document DNR discussions in the patient's medical record under Section 30 of the National Health Act 2014. The Federal High Court, State High Courts, and in some cases the National Industrial Court of Nigeria (NICN) have jurisdiction over disputes about medical decision-making. The Nigeria Data Protection Regulation (NDPR) 2019 requires healthcare providers to obtain explicit consent before processing sensitive health data under Regulation 2.2. Islamic Medical Association of Nigeria (IMAN) guidelines and MDCN ethical standards apply in cases where religious convictions inform the directive.

A Nigeria Advance Directive and DNR declaration should contain the following essential components to be as effective as possible within the current Nigerian legal and clinical environment.

Declarant's identity: Full name, date of birth, address, and National Identification Number (NIN) or passport number of the person making the directive. Confirmation that the declarant is an adult of sound mind and full decision-making capacity at the time of execution.

Statement of purpose: A clear statement that the document is an advance directive recording the declarant's wishes about medical treatment, to take effect if the declarant loses the capacity to make or communicate medical decisions.

Specific medical wishes: The declarant's specific instructions about particular treatments, including: CPR (do not attempt resuscitation / DNAR, or consent to CPR); mechanical ventilation (consent to or refusal of artificial breathing support); artificial nutrition and hydration (consent to or refusal of tube feeding or IV fluids for sustaining life only); dialysis (consent to or refusal of kidney dialysis); and surgery (consent to or refusal of surgical intervention intended only to prolong life where there is no reasonable prospect of recovery).

DNR specific provision: If the declarant wishes a DNR order, a clear unambiguous statement that cardiopulmonary resuscitation (CPR) should not be attempted if the declarant's heart stops or breathing ceases. The clinical context in which the DNR applies should be stated (e.g., any circumstance, or only in the context of a terminal illness or following a specified medical event).

Healthcare proxy appointment: The name, address, and contact details of a trusted person (healthcare proxy or healthcare attorney) whom the declarant authorises to communicate their wishes to medical staff and to make medical decisions on the declarant's behalf where the directive does not address a specific situation. Confirmation of the proxy's acceptance of the role.

Religious and values statement: A brief statement of the declarant's religious beliefs, personal values, and the reasons for their medical decisions — this context helps medical staff and family understand the basis for the directive and supports its implementation.

Geographic scope: A statement that the directive applies to all Nigerian healthcare facilities, including public hospitals, private hospitals, and any location in Nigeria where the declarant receives medical care.

Revocation: A statement of the declarant's right to revoke the directive at any time while they retain decision-making capacity, by written revocation delivered to their treating physician and healthcare proxy.

Witnesses and signatures: The directive must be signed by the declarant in the presence of two adult witnesses who are not the healthcare proxy and who are not beneficiaries under the declarant's will. Both witnesses must sign confirming that the declarant appeared to be of sound mind and signed voluntarily. The signature of a treating physician who has discussed the directive with the declarant adds significant clinical weight.

Compliance checklist for an Advance Directive / Do Not Resuscitate Order (Nigeria): Section 23 of the National Health Act 2014 must be cited as the statutory basis for the treatment refusal. The Medical and Dental Council of Nigeria (MDCN), established under the Medical and Dental Practitioners Act Cap M8 LFN 2004, requires the treating physician to document the directive in the hospital record and confirm the patient's decision-making capacity. Section 34 of the Constitution of the Federal Republic of Nigeria 1999 (right to dignity) and Section 38 (freedom of religion) support the directive's constitutional basis. The Evidence Act 2011 (Section 83) governs admissibility of the document before the Federal High Court or a State High Court. The Nigeria Data Protection Regulation (NDPR) 2019 (Regulation 2.3) requires explicit consent for processing health data. The National Health Act 2014 (Section 26) protects health workers who act in good faith in compliance with an advance directive. The Nigerian Data Protection Commission (NDPC) enforces data rights over medical records. Forms-legal.com provides this template as a starting point for Nigeria-compliant documentation. Consult a Nigerian Legal Practitioner enrolled at the Supreme Court of Nigeria for complex cases.