Do-not-resuscitate order
Definition
A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
Alternative Names
No code; End-of-life; Do not resuscitate; Do not resuscitate order; DNR; DNR order; Advance care directive - DNR; Health care agent - DNR; Health care proxy - DNR; End-of-life - DNR; Living will - DNR
What is a DNR?
Ideally, a DNR order is created, or set up, before an emergency occurs. A DNR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition.
The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient's family.
What is Resuscitation?
CPR is the treatment you receive when your blood flow or breathing stops. It may involve:
- Simple efforts such as mouth-to-mouth breathing and pressing on the chest
- Electric shock to restart the heart
- Breathing tubes to open the airway
- Medicines
Making the Decision
If you are near the end of your life or you have an illness that will not improve, you can choose whether you want CPR to be done.
- If you do want to receive CPR, you do not have to do anything.
- If you do not want CPR, talk with your doctor about a DNR order.
These can be hard choices for you and those who are close to you. There is no hard and fast rule about what you may choose.
Think about the issue while you are still able to decide for yourself.
- Learn more about your medical condition and what to expect in the future.
- Talk to your doctor about the pros and cons of CPR.
A DNR order may be a part of a hospice care plan. The focus of hospice care is not to prolong life, but to treat symptoms such as pain or shortness of breath, and to maintain comfort.
If you have a DNR order, you always have the right to change your mind and request CPR.
How is a DNR Order Created?
If you decide you want a DNR order, tell your doctor and health care team what you want. Your doctor must follow your wishes, or:
- Your doctor may transfer your care to a doctor who will carry out your wishes.
- If you are a patient in a hospital or nursing home, your doctor must agree to settle any disputes so that your wishes are followed.
The doctor can fill out the form for the DNR order.
- The doctor writes the DNR order in your medical record if you are in the hospital.
- Your doctor can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings.
- Standard forms may be available from your state's Department of Health.
Make sure to:
- Include your wishes in an advance care directive (living will)
- Inform your health care agent (also called health care proxy) and family of your decision
If you do change your mind, talk with your doctor or health care team right away. Also tell your family and caregivers about your decision. Destroy any documents you have that include the DNR order.
When You are Unable to Make the Decision
Due to illness or injury, you may not be able to state your wishes about CPR. In this case:
- If your doctor has already written a DNR order at your request, your family may not override it.
- You may have named someone to speak for you, such as a health care agent. If so, this person or a legal guardian can agree to a DNR order for you.
If you have not named someone to speak for you, under some circumstances, a family member can agree to a DNR order for you, but only when you are not able to make your own medical decisions.
References
Arnold RM. Palliative care. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 3.
Bullard MK. Medical ethics. In: Harken AH, Moore EE, eds. Abernathy's Surgical Secrets. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 106.
Moreno JD, DeKosky ST. Ethical considerations in the care of patients with neurosurgical disease. In: Cottrell JE, Patel P, eds. Cottrell and Patel's Neuroanesthesia. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 26.
Review Date:1/18/2022
Reviewed By:David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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