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Definition

A do-not-resuscitate order, or DNR order, is a medical order written by a health care provider. It instructs providers not to do CPR (cardiopulmonary resuscitation) if a patient's breathing stops or if the patient's heart stops beating.

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 provider writes the order only after talking about it with the patient (if possible), the health care 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 or not.

• If you do want to receive CPR, you do not have to do anything.
• If you do not want CPR, talk with your provider about a DNR order.
• Either way, it is best to discuss your desires with your providers and family before it becomes an urgent decision.

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 provider 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 if necessary.

How is a DNR Order Created?

If you decide you want a DNR order, tell your provider and health care team what you want. Your provider must follow your wishes, or:

• Your provider may transfer your care to a provider who will carry out your wishes.
• If you are a patient in a hospital or nursing home, your provider must agree to settle any disputes so that your wishes are followed.

Your provider can fill out the form for the DNR order.

• Your provider writes the DNR order in your medical record if you are in the hospital.
• Your provider can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings, so that emergency medical personnel will be able to understand your DNR status.
• 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 provider 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 provider 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, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

National Institute on Aging website. Advance Care Planning: Advance Directives for Health Care. www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care#find. Updated October 31, 2022. Accessed February 13, 2024.

Shreves A, Quest TE. End of life. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap e5.

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