The question of performing cardiopulmonary resuscitation (CPR) on an individual with a Do Not Resuscitate (DNR) order is rooted in medical ethics, patient rights, and legal protocol. A DNR order represents a person’s explicit wish to decline life-saving interventions at the end of life, prioritizing comfort and a natural death over aggressive medical measures. This advance directive is a critical component of end-of-life care planning, designed to ensure a person’s autonomy is respected. Understanding the specific nature and scope of this order is paramount for all involved parties.
Understanding DNR Orders
A Do Not Resuscitate (DNR) order is a formal medical instruction, signed by a physician and the patient or their authorized surrogate, that prohibits the use of CPR if the patient’s heart or breathing stops. This advance directive applies only to resuscitation efforts. The scope of a DNR order includes withholding chest compressions, artificial ventilation, and defibrillation.
A DNR order does not mean “do not treat” or “abandon care.” A person with a DNR order still receives all other necessary medical care, including pain management, antibiotic therapy, and wound care, intended for comfort or cure. The DNR prevents the initiation of aggressive and invasive measures that are unlikely to be successful for a person near the end of life. Other documents, such as a Living Will, address broader end-of-life treatment preferences like the use of a feeding tube or ventilator, while the DNR focuses specifically on cardiac or respiratory arrest.
The Direct Answer Regarding CPR
The explicit answer to whether CPR should be performed on someone with a valid DNR order is no; resuscitation attempts must be withheld. Once a valid and properly identified DNR order is in place, medical personnel and emergency responders are legally and ethically obligated to honor the patient’s wishes. Failure to respect a known, valid DNR order violates patient autonomy and may lead to legal consequences for healthcare providers, including liability for battery or malpractice.
This requirement affirms the patient’s right to self-determination over their medical treatment. For personnel adhering to the order, the focus shifts to providing comfort care and support to the patient and their family. Comfort care measures may include positioning, suctioning the airway, administering oxygen, and providing pain medication, all aimed at ensuring a peaceful and dignified process. The DNR order represents a decision made after a discussion about the low success rates and potential complications of CPR.
Distinguishing Between In-Hospital and Out-of-Hospital DNRs
Honoring a DNR order depends significantly on the setting, requiring a distinction between In-Hospital and Out-of-Hospital DNRs. An In-Hospital DNR is documented within the patient’s medical chart, often referred to as a “no code” order, and is readily accessible to the facility’s staff, such as in a hospital, nursing home, or hospice unit. This setting provides a controlled environment where the order’s validity is easily confirmed by the medical team.
The Out-of-Hospital DNR, or Portable DNR, is designed for individuals in community settings, including private residences, assisted living facilities, or during transport. For this order to be effective, it must meet specific state-regulated requirements and be immediately available to Emergency Medical Services (EMS) personnel.
These protocols often require a state-specific form, which must be signed by both the patient and a physician, and may be accompanied by unique identification devices. Common identification methods include brightly colored paper forms, wallet cards, or wearable jewelry such as bracelets or necklaces engraved with the DNR status. EMS providers are trained to look for these specific identifiers; without a valid, visible out-of-hospital DNR form or identification, they are generally required to initiate resuscitation efforts. Many states have incorporated these instructions into comprehensive portable medical orders like Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST) forms, which detail a broader range of life-sustaining treatments beyond just CPR.
Actions When DNR Status is Unknown or Ambiguous
In the absence of clear, legally valid DNR documentation, the universal protocol for all emergency responders is to initiate and continue full resuscitation efforts. This is known as the “default to save” protocol, which operates on the presumption of consent for life-saving interventions. The rationale is that the potential for saving a life outweighs the risk of violating a patient’s unknown preference.
Time is critical during cardiac arrest, and emergency personnel are not required to spend valuable minutes searching for paperwork or questioning family members. If an EMS provider cannot immediately confirm a valid DNR status through the required state-specific form or identification, they must proceed with CPR and all necessary advanced life support measures. Should valid documentation become available after resuscitation has begun, the medical team is required to cease all resuscitation efforts, adhering to the patient’s documented wishes.