Do not resuscitate orders

Do Not Resuscitate Order
A do not resuscitate order, or DNR, is a medical order written by a doctor. It instructs health care providers not to docardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating.

A DNR order allows you to choose before an emergency occurs whether you want CPR. It is a decision only about CPR. It does not affect other treatments, such as pain medicine, medicines, or nutrition.

The doctor writes the order only after talking about it with the patient (if possible), the proxy, or family.

What Is Resuscitation?
CPR is the treatment you receive when your blood flow or breathing stops.

CPR may involve:

• Simple efforts such as mouth-to-mouth breathing and pressing on the chest.  
• Electric shock to restart the heart,
• Reading 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 don't 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 this care is on treating symptoms of pain or shortness of breath to maintain comfort, but not to prolong life.

If you have a DNR order, you always have the right to change your mind and request CPR.

How to Create a DNR Order
If you decide you want a DNR order, tell your doctor what you want. Your doctor must follow your wishes, or:

• Your doctor must transfer your care to a doctor who will carry out your wishes.
• Your doctor must agree to settle the dispute within 72 hours if you are a patient in a hospital or nursing home so that your wishes are followed.

The doctor can fill out the form for the DNR order.

• The doctor writes the DNR order on your medical chart 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 a non- hospital setting.
• Standard forms may be available from your state’s Department of Health.

Make sure to:

• Include your wishes in a living will or health care power of attorney.
• Inform your health care proxy and family of your decision.

If you do change your mind, talk with your doctor right away. Also tell your family and caregivers about your decision. Destroy any documents that you may have that state the DNR order.

When You Are Unable to Make the Decision
Due to illness you may not be able to state your wishes about CPR.

• If your doctor has written a DNR order already at your request, your family cannot 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, a family member or friend can agree to a DNR order for you only when:

• You are terminally ill.
• You are permanently unable to decide.
• CPR will not work.
• CPR could cause more medical problems for you.

Alternate Names
No code; End-of-life - do not resuscitate; DNR

Update Date: 4/7/2012
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.