A Do-Not-Resuscitate (DNR) order is an advance directive that tells healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops beating or they stop breathing. In simple terms, it’s a way for patients to express that they do not want life-sustaining measures, like chest compressions, electric shocks, or assisted breathing, if their body naturally shuts down.
Understanding what a DNR order means is crucial for patients, families, and healthcare providers. It’s not about “giving up” or withholding care; it’s about respecting a person’s right to choose the type of medical treatment they want at the end of life. These decisions often come into play for people with serious or terminal illnesses, where CPR may not improve quality of life or may only prolong suffering.
Despite being an important part of advanced care planning, DNR orders are often misunderstood. Some believe that a DNR means no medical care at all, which isn’t true. A DNR only applies to resuscitation efforts; it doesn’t stop doctors and nurses from providing palliative care, pain management, or other treatments that keep the patient comfortable and supported.
Who Can Request a DNR Order?
A DNR (Do Not Resuscitate) order can be requested by an adult patient, their family, or their medical agent if the patient is unable to speak for themselves.
- An Adult Patient: The patient can directly request a do not resuscitate if they can make decisions about their care. This lets them control which life-saving measures they want or do not want.
- Healthcare Proxy or Agent: A healthcare proxy or agent can ask for a do not resuscitate if the patient cannot speak for themselves. They act on the patient’s behalf and follow the person’s known wishes.
- Family or Close Relatives: Family members or close relatives may request a do not resuscitate when the patient cannot communicate. They provide guidance based on what they believe the patient would want.
- Physician: A physician can recommend or write a do not resuscitate based on the patient’s medical condition and prognosis. They ensure the decision follows legal rules and respects the patient’s health choices.
When and Why a Doctor Might Suggest a DNR
A doctor may suggest a Do-Not-Resuscitate (DNR) order in situations where resuscitation would not provide meaningful benefit or could cause more harm than good. Common circumstances include.
1. When a DNR Might Be Suggested
- The patient has a terminal illness or advanced-stage disease.
- The patient is elderly with multiple serious health conditions.
- The patient’s overall prognosis is poor, and resuscitation is unlikely to improve quality of life.
- The patient is in the final stages of life, where medical interventions may be more burdensome than beneficial.
2. Why a DNR Might Be Suggested
- To avoid unnecessary or painful medical procedures that may not extend life meaningfully.
- To respect the patient’s wishes regarding end-of-life care.
- To focus on comfort care rather than aggressive interventions.
- To ensure ethical and medically appropriate treatment aligned with the patient’s condition.
In short, a doctor suggests a DNR to prioritize patient comfort, dignity, and quality of life when resuscitation is unlikely to be beneficial.
What Are the 2 Types of DNR?
The two main types of Do Not Resuscitate (DNR) orders, based on where the care takes place and the patient’s personal wishes. They are as follows.
1. In-Hospital Do-Not-Resuscitate (DNR)
This type of DNR is used when a patient is receiving care inside a hospital. It tells the medical team not to perform CPR or other life-saving procedures if the heart or breathing stops. The order is clearly written in the patient’s hospital chart and signed by the doctor to make sure everyone on the care team follows it.
2. Out-Hospital Do-Not-Resuscitate (DNR)
This DNR applies when a person is outside a hospital, such as at home, in a nursing facility, or during transport. It guides emergency responders to respect the patient’s wish not to receive CPR. The order is documented on a special form or card that should be easily seen, so paramedics and first responders know what to do right away.
What Procedures Does a DNR Cover?
A Do Not Resuscitate (DNR) order is a medical directive that instructs medical providers not to perform CPR if the patient’s heart stops or breathing ceases. It also means that defibrillation and artificial ventilation or intubation should not be used, respecting the individual’s choice to avoid aggressive life-saving measures.
1. Cardiopulmonary Resuscitation (CPR)
A DNR order tells medical providers not to perform CPR if the heart stops beating or breathing stops. This means chest compressions and rescue breaths are not started, allowing the person to pass naturally according to their wishes.
2. Defibrillation
Defibrillation uses electric shocks to restart the heart during cardiac arrest. A DNR order directs medical staff not to use this procedure, respecting the decision to avoid aggressive life-sustaining measures.
3. Artificial Ventilation or Intubation
This procedure helps a person breathe by placing a tube into the airway and connecting it to a machine. When a DNR is in place, medical teams do not perform intubation or use a breathing machine, honoring the patient’s choice for comfort-focused care.
However, a DNR order does not cover the following points
- Other medical treatments, such as pain management, medications, and surgery
- Supportive care, such as hydration, nutrition, and emotional support.
- Decisions about long-term care or end-of-life planning.
How to Obtain a DNR Order
To obtain a DNR, you have to follow the points below. The process requires a doctor’s involvement because a do not resuscitate is a medical order, not simply a personal declaration.
- Talk to Your Doctor: Start by having an open conversation with your doctor about your wishes for medical care. They can explain what a do not resuscitate order means and help you decide if it’s the right choice for you.
- Complete the Legal Form: Once you’re ready, fill out the official do not resuscitate form for your state. Your doctor or a medical provider can guide you through the process to make sure everything is done correctly.
- Get the Necessary Signature: A do not resuscitate order must be signed by your doctor to make it valid. This signature confirms that your choice has been reviewed and properly documented.
- Distribute and Keep Copies: After the form is signed, share copies with your family, doctor, and local hospital. Keep one in an easy-to-find place so emergency responders can see it right away.
DNR vs. Other Advance Directives
Understanding the difference between a do not resuscitate order and other advance directives helps patients and families make informed choices about future medical care. Each serves a unique purpose in honoring personal wishes and guiding medical decisions.
| Feature | DNR |
Other Advance Directives (eg, Living Will, Healthcare Power of Attorney) |
| Types of Documents | A medical order that requires signatures from both the physician and the patient. | Legal paperwork outlining general preferences for healthcare decisions. |
| Scope | Focuses only on resuscitation efforts such as CPR or intubation when cardiac or respiratory arrest occurs. | Addresses a broad range of medical treatments, like mechanical ventilation, artificial nutrition, pain management, and organ donation, as well as overall care choices. |
| Activation | Becomes active as soon as it’s signed and added to the patient’s medical record. | Usually takes effect only when the individual is terminally ill, permanently unconscious, or unable to communicate medical decisions. |
| Portability | Hospital DNRs are valid only within that facility, while out-of-hospital DNRs or POLST forms can travel with the patient and are recognized by emergency responders. | Generally valid across multiple healthcare settings, though portability rules may differ depending on the state. |
| Purpose | To refuse resuscitation or other life-saving interventions when recovery is unlikely or life quality is severely diminished. | To document and uphold a patient’s medical wishes across a variety of medical situations, or to designate a trusted decision-maker if the patient becomes incapacitated. |
- A Do Not Resuscitate (DNR) order is a specific directive that applies only in emergencies when a person’s heart or breathing stops.
- An Advance Directive, such as a Living Will or a Health Care Power of Attorney, is a broader document outlining a person’s overall preferences for future healthcare, which may include a wish for a DNR but covers many other situations as well.
Although an advance directive can express a person’s wishes about resuscitation, a separate DNR order signed by a physician is required for those wishes to be immediately followed by all medical professionals, including emergency responders.
DNR: Care with Dignity
In short, a Do-Not-Resuscitate order is about giving people control over their medical care and respecting their wishes at a critical time. It clearly outlines what should happen if the heart or breathing stops, while still allowing doctors and nurses to provide comfort and support. Understanding how to request a DNR, what it covers, and how it differs from other advance directives helps patients and families make thoughtful decisions. By knowing these details, everyone involved can focus on dignity, comfort, and the type of care that truly matters to the person.
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