A Do Not Resuscitate (DNR) order is a specific medical instruction written by a physician that respects a patient’s choice to refuse life-saving measures in the event of cardiopulmonary arrest. It is a formal medical order documented in the patient’s chart, distinguishing it from an advance directive or living will, which are broader legal documents outlining future healthcare preferences. This order ensures a patient’s autonomy is honored concerning aggressive interventions when the medical prognosis is poor. The DNR order guides the medical team by clearly defining the limits of emergency care when the heart or breathing stops.
Medical Scope of a Do Not Resuscitate Order
The DNR order focuses narrowly on the refusal of procedures intended to restart the heart or breathing after they have ceased, a condition known as cardiopulmonary arrest. When this event occurs, the DNR prohibits specific, aggressive interventions designed to reverse the arrest. These prohibited actions include chest compressions (CPR) and artificial ventilation, such as intubation and mechanical breathing support.
The order also explicitly forbids the use of electrical shock therapies, including defibrillation and cardioversion. Additionally, the administration of emergency cardiac medications, such as epinephrine and atropine, which are part of Advanced Cardiac Life Support (ACLS) protocols, must be withheld. A valid DNR order directs all healthcare providers to allow a natural death process rather than intervening with these specific resuscitative measures.
It is a common misconception that a DNR is a “Do Not Treat” order; however, it is strictly limited to the refusal of resuscitation. The order permits all other necessary and appropriate medical care designed to maintain comfort, manage symptoms, and treat non-cardiac conditions. This includes comfort care, pain medication, palliative treatments, and general nursing care.
A patient with a DNR order will still receive antibiotics for an infection, nutritional support, hydration, and diagnostic testing. The intent of the order is to prevent invasive interventions like CPR, not to abandon the patient or withhold treatment for reversible medical issues. Medical professionals are obligated to continue offering all care that is not defined as a resuscitative effort.
Establishing and Documenting the Decision
The process of establishing a DNR order begins with a detailed discussion between the patient or their authorized representative and a qualified healthcare provider, such as a physician. This conversation covers the patient’s values, prognosis, and the likely outcomes of resuscitation given their current health status. For the order to be valid, the patient must be competent to make the decision, or the legally designated healthcare agent must act on the patient’s behalf.
The physician must then formally translate the patient’s wishes into a medical order by documenting it in the patient’s permanent medical record. Oral requests for a DNR are sometimes honored temporarily in a hospital setting, but a written order is required for the directive to be permanent and binding. This documentation is crucial because the DNR must be instantly accessible and unambiguous for all members of the healthcare team.
In many regions, specific portable medical forms are used to document these preferences, such as Physician Orders for Life-Sustaining Treatment (POLST) or Medical Orders for Life-Sustaining Treatment (MOLST). These forms are legally binding medical orders that travel with the patient across different care settings. They often allow for a more nuanced selection of life-sustaining treatments beyond CPR, such as defining limits on mechanical ventilation or feeding tubes.
There is a distinction between an in-hospital DNR and an out-of-hospital DNR (OOH-DNR) form. An in-hospital order is generally only valid within that specific facility. For emergency medical services (EMS) personnel to honor the directive in a non-hospital environment, a state-specific OOH-DNR form or specialized DNR identification, like a bracelet or necklace, is typically required.
Changing or Transferring the Order
A DNR order is not permanent and can be revoked or suspended at any time by the patient, provided they are mentally capable of making that decision. Revocation is straightforward and can be accomplished simply by the patient or their healthcare agent communicating a clear desire to receive resuscitation to any healthcare provider. The medical team will then immediately remove the order from the patient’s chart.
The portability of a DNR order is limited and depends heavily on the specific documentation used. While an OOH-DNR form is designed to be honored by EMS personnel outside of a hospital, a standard hospital-based DNR order is often not recognized in the community. Patients must ensure they possess the correct, state-approved documentation if they wish the directive to be followed by first responders in any location.
If a patient is transferred between healthcare facilities, the DNR order must be actively transferred and re-verified by the receiving facility’s physician. This ensures continuity of care and prevents the order from being inadvertently overlooked in a new medical environment. A patient’s preferences must be consistently reviewed and confirmed, especially when their medical condition changes or before an elective surgery.