Cardiopulmonary Resuscitation (CPR) is the standard emergency response when a person’s heart or breathing stops. However, a Do Not Resuscitate (DNR) order introduces a conflict to this automatic action. Clarity regarding this medical order is crucial for ensuring a patient’s autonomy is respected at the most critical time. The existence of a valid DNR order changes the entire protocol for medical professionals responding to a life-threatening event.
Understanding Do Not Resuscitate (DNR) Orders
CPR is an emergency procedure used to restart the heart and lungs following cardiac or respiratory arrest. Resuscitation efforts include chest compressions, artificial ventilation, electric shock (defibrillation), insertion of a breathing tube (intubation), and the injection of medications. CPR is an invasive intervention, and medical providers are obligated to attempt it without specific instruction to the contrary.
A Do Not Resuscitate (DNR) order is a formal, legally binding medical instruction that explicitly tells medical staff not to perform CPR or other resuscitative efforts if the patient’s heart or breathing ceases. This order must be signed by both the patient (or their legally authorized surrogate) and a physician. The philosophy behind a DNR is to respect patient autonomy, particularly for individuals with terminal illnesses or advanced frailty who wish to avoid the trauma of CPR.
A DNR order represents an informed choice to prioritize a natural death and avoid aggressive interventions. While the order prohibits CPR, it does not mean “do not treat.” The patient still receives all other appropriate medical care, such as antibiotics, dialysis, or pain management.
The Definitive Answer: CPR Is Not Performed
When a valid DNR order is in place and a patient experiences cardiac or respiratory arrest, medical professionals are legally and ethically required to withhold CPR. The DNR overrides the default medical protocol, ensuring the patient’s documented wishes are honored. This directive prohibits all procedures associated with resuscitation, including chest compressions, artificial ventilation, defibrillation, and the use of resuscitative drugs.
Instead of aggressive life-prolonging measures, the focus shifts entirely to comfort care, also known as palliative care. This approach ensures the patient remains free of pain and receives interventions to manage symptoms and maintain dignity. A patient with a DNR order will still receive oxygen, pain medication, and other treatments aimed at comfort.
The presence of a DNR order means the medical team will not attempt to restart the heart or breathing, but they will provide all non-resuscitative medical care needed for other conditions. The DNR status only applies to the specific event of cardiopulmonary arrest. Should a patient with a DNR break a bone or contract an infection, they will receive full treatment for those conditions.
Different Types of DNR Documentation and Applicability
DNR orders are not uniform documents; their validity and applicability can depend heavily on the setting and the specific documentation used. An In-Hospital DNR is typically part of the patient’s medical chart and is only valid within that specific facility, such as a hospital or nursing home. These orders may expire upon discharge, requiring a new discussion and order if the patient is readmitted.
For a DNR to be honored outside a clinical setting, an Out-of-Hospital DNR (OOH-DNR) form is required. This portable document is designed to be presented to Emergency Medical Services (EMS) personnel or other first responders who may be called to a home or public place. To ensure the order is immediately recognizable, patients are often advised to keep the form readily accessible, such as posted near the bed, or to wear an identifying bracelet or necklace.
Some states use standardized forms that go beyond a simple DNR, such as Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST). These forms are actual medical orders signed by a physician and travel with the patient across different care settings. They specify a broader range of end-of-life treatments, including decisions about mechanical ventilation and feeding tubes, in addition to CPR.
Legal Protections for Following the Order
Healthcare providers, including physicians, nurses, and EMS personnel, have a legal obligation to honor a patient’s valid DNR order. Ignoring a known and valid DNR can lead to serious legal consequences for the medical professional, including claims of medical negligence or battery, as it violates the patient’s right to refuse treatment. The law supports a patient’s autonomy to determine what is done to their own body.
The situation is different for lay bystanders who are not trained healthcare professionals. In most jurisdictions, a bystander who attempts CPR is protected by Good Samaritan laws, even if the person has a DNR order. These laws shield the public from liability when acting in good faith to save a life, and bystanders are not expected to search for DNR documentation before initiating aid.
Trained professionals, however, must pause to verify the existence of a valid DNR order. If an EMS worker is presented with a valid OOH-DNR form or identifying device, they must adhere to it. Clear communication among the patient, family, and medical team is therefore paramount to ensure the patient’s end-of-life wishes are documented correctly and honored by all responding parties.