A Do Not Resuscitate (DNR) order is a formal medical instruction used in end-of-life planning. It directs healthcare providers to withhold specific life-saving interventions if a patient’s heart or breathing stops. This ensures an individual’s preference to forgo aggressive measures is respected during a medical crisis.
Defining Resuscitation and the DNR Scope
The term “resuscitation” in a medical setting refers to a set of aggressive, invasive procedures intended to restore heart function and breathing after they have ceased. A DNR order is specifically designed to stop these procedures from being attempted. The primary procedure withheld is Cardiopulmonary Resuscitation (CPR), which involves chest compressions and rescue breathing.
A DNR also covers other advanced interventions that follow CPR, such as defibrillation, which is the use of electrical shock to restart the heart’s rhythm. Additionally, the order typically prohibits artificial ventilation, which involves intubation—inserting a tube down the throat to connect the patient to a breathing machine. These measures are often invasive and carry a low success rate, particularly for individuals with severe or terminal illnesses.
It is a common misunderstanding that a DNR means “do not treat,” but this is entirely inaccurate. The order only applies to the specific actions required to restart the heart and lungs following cardiac or respiratory arrest. All other medical care, including pain management, comfort measures, antibiotics, and ongoing treatment for other conditions, must continue to be provided.
The Process of Establishing a DNR Order
Creating a DNR order begins with a thorough conversation between the patient and a physician or authorized healthcare provider. This discussion ensures the patient has informed consent, fully understanding the nature and consequences of the order. The patient’s medical condition, prognosis, and the likely outcomes of resuscitation are all factors considered.
The patient’s decision-making capacity is assessed. If the patient is unable to communicate their wishes, a legally authorized surrogate steps in, often a healthcare agent or family member. The surrogate makes the decision based on the patient’s known values and preferences. The physician then formally writes the DNR order into the patient’s medical chart, ensuring it is documented and accessible to all medical staff.
The DNR is a distinct medical order and should not be confused with a living will or general advance directive. While those documents express broader end-of-life wishes, the DNR is a specific instruction to healthcare providers regarding resuscitation. Without the formal, signed DNR order in the medical record, healthcare professionals are generally obligated to attempt resuscitation if the heart or breathing stops.
DNR Orders Outside the Hospital Setting
A standard DNR order placed in a patient’s medical chart is effective within a hospital or healthcare facility. However, this order may not be recognized by Emergency Medical Services (EMS) personnel responding to an emergency outside the facility. This is because EMS providers operate under different protocols and require specific, portable documentation.
To address this, most states have established specific forms, often called Out-of-Hospital DNR (OOH-DNR) orders. These forms are designed to be immediately recognizable and legally binding for paramedics and EMTs. Some states utilize a broader document known as Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST).
POLST and MOLST forms are medical orders that travel with the patient across different care settings. They often address choices beyond resuscitation, such as intubation or the use of feeding tubes. These documents are usually printed on distinctively colored paper, like bright pink or green, to stand out. Patients with an OOH-DNR or POLST are encouraged to wear a state-approved bracelet or medallion to alert EMS personnel quickly.
Patient Autonomy and Reversing the Order
A patient maintains complete autonomy over their medical care, including the right to reverse or revoke a DNR order at any time. This right is independent of the patient’s medical condition, provided they have the capacity to communicate the decision. The patient’s most recent wishes always take precedence.
The order can be revoked simply by the patient verbally informing their healthcare provider or any responding medical professional. If the patient is unable to speak, their legally authorized healthcare agent can communicate the revocation. To finalize the change, the provider must remove the DNR order from the medical record, and any physical forms, bracelets, or medallions should be destroyed.