A Do Not Resuscitate (DNR) order is a medical instruction used to prevent unwanted life-saving interventions if a person’s heart or breathing stops. The order specifically directs healthcare providers to withhold cardiopulmonary resuscitation (CPR) and related procedures. Its core function is to honor a patient’s preference for a natural death, avoiding aggressive measures that may be medically futile or cause significant discomfort near the end of life.
A DNR is a specific medical order placed in a patient’s chart, reflecting a patient’s autonomy over medical treatment. It is not a broad legal document covering all end-of-life decisions.
Defining the Scope of a DNR Order
A DNR order precisely defines the medical interventions that are to be withheld from a patient experiencing cardiac or respiratory arrest. The primary procedure excluded is cardiopulmonary resuscitation (CPR), which involves chest compressions and artificial ventilation. Since resuscitation is a process, the DNR order also covers other linked life-support measures. These measures include defibrillation, artificial ventilation (such as intubation and mechanical support), and emergency medications intended to stimulate the heart, like certain vasopressors.
The presence of a DNR order does not mean that a patient receives no medical treatment at all. It is strictly limited to withholding resuscitation attempts, not a general “do not treat” order. Patients with a DNR continue to receive full medical care for all other conditions, including pain medication, antibiotics, and wound care. This focus on comfort is often referred to as palliative care, which is always provided regardless of a patient’s DNR status.
The order is narrowly focused on the immediate, emergency situation of cardiac or respiratory arrest. Other life-sustaining treatments, like the use of a ventilator or dialysis, are separate decisions that are not automatically stopped by a DNR. The physician ensures the patient understands that the DNR only applies to procedures necessary to restart the heart or breathing. The success rate of CPR is often low, particularly for those with advanced or chronic illnesses, making the choice to forgo it an informed medical decision.
The Process of Establishing a DNR
Establishing a valid DNR order requires patient consent and physician documentation. The process begins with a detailed discussion between the patient and their attending physician about the patient’s condition, the nature of CPR, and the likely outcomes of resuscitation attempts. If the patient is unable to communicate, the discussion must occur with the legally authorized surrogate decision-maker or healthcare proxy. This ensures the patient or representative makes an informed decision with a clear understanding of what a DNR withholds and what care will continue.
A DNR is a medical order, meaning it must be documented and signed by a physician to be legally and medically effective. The physician writes the order directly into the patient’s medical record, which then instructs all members of the healthcare team. Most states require the order to include specific instructions about which interventions are to be withheld, such as chest compressions, intubation, and electric shocks. Simply stating a preference in a living will is not sufficient; a physician’s signature is required to translate the preference into an actionable medical order.
Documentation requirements differ significantly based on the patient’s location. An in-hospital DNR order is placed in the patient’s chart while they are admitted and is immediately recognized by hospital staff. For patients outside of a hospital setting, such as at home or in a nursing facility, a specific Out-of-Hospital DNR (OOH-DNR) form is necessary. These portable forms are legally recognized by emergency medical services (EMS) personnel, who are otherwise required to attempt resuscitation.
OOH-DNR forms often must be a specific color, such as pink or orange, and kept in an easily accessible location, like on the refrigerator, to be quickly found by first responders. Some states provide patients with a medical identification device, like a bracelet or necklace, which serves as a portable indication of the OOH-DNR status. The OOH-DNR must also be signed by both the patient or surrogate and the physician to be valid for emergency situations outside of the healthcare facility.
Flexibility and Related Healthcare Directives
Despite being a formal medical order, a DNR is not permanent and can be revoked or changed at any time by the patient. If the patient is competent, they can communicate their desire to revoke the DNR verbally or in writing, and the revocation becomes effective immediately. The patient can even verbally request resuscitation from emergency personnel, which legally overrides an existing DNR order. If the patient is not competent, the legally authorized surrogate can also revoke the order.
The decision to revoke a DNR is documented in the patient’s medical record, and any existing DNR identification, such as a bracelet or paper form, should be removed or destroyed. This flexibility is a safeguard of the patient’s right to self-determination, ensuring that medical decisions can evolve as their health condition or personal preferences change.
A DNR order is frequently confused with broader advance directives, but it is distinct from documents like a Living Will or a Durable Power of Attorney for Healthcare (DPOA-HC). A Living Will is a legal document that expresses a patient’s preferences for long-term medical care if they are terminally ill or permanently unconscious. The DPOA-HC, or healthcare proxy, designates a specific person to make medical decisions on the patient’s behalf if they lose capacity. While a Living Will might state a preference to forgo resuscitation, the DNR is the physician-signed order that makes that preference immediately enforceable in an emergency.