DNR: What Is a Do-Not-Resuscitate Order?
Understanding DNR orders: A comprehensive guide to end-of-life medical decisions and your healthcare rights.
What Is a Do-Not-Resuscitate Order?
A do-not-resuscitate order, commonly known as a DNR, is a legal medical document that communicates your wishes regarding cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Also called a “do not attempt resuscitation” (DNAR) or “do not attempt cardiopulmonary resuscitation” (DNACPR) order, a DNR is a set of instructions that tells your healthcare team what kind of medical intervention you do and don’t want at the end of your life. This advance directive ensures that your end-of-life medical care aligns with your personal beliefs, values, needs, and desires as closely as possible.
It’s important to understand that a DNR order is specifically about CPR and cardiac or respiratory arrest. It does not mean “do not treat.” Rather, it means that if your heart stops beating or you stop breathing, healthcare providers will not attempt to restart your heart through CPR. The order becomes operative only in the narrow context of cardiac or respiratory arrest, regardless of the precipitating clinical event.
Understanding What a DNR Order Does and Does Not Do
One of the most common misconceptions about DNR orders is that they prevent all medical treatment. This is a dangerous misunderstanding. A DNR order is a decision about CPR alone and does not affect other treatments that may be used to help keep you alive.
What a DNR Order Does
When a DNR order is in place and you experience cardiac or respiratory arrest, healthcare providers will not attempt CPR. This means that the following resuscitative measures will also be avoided:
- Chest compressions
- Mouth-to-mouth resuscitation
- Electric shocks to the heart (defibrillation)
- Insertion of breathing tubes (endotracheal intubation)
- Artificial ventilation
- Injection of emergency medications for cardiac resuscitation
What a DNR Order Does Not Do
A DNR order does not prevent other medical treatments. You can still receive:
- Antibiotic therapy for infections
- Blood transfusions
- Dialysis for kidney failure
- Mechanical ventilation for respiratory support (unless otherwise specified)
- Medications for pain management and comfort
- Palliative care to keep you free of pain and comfortable
- Nutrition and hydration support
- Other life-sustaining interventions appropriate to your condition
In many cases, these other treatments are more likely to be successful than CPR, particularly near the end of life when the success rate of CPR is extremely low.
Why CPR Success Rates Matter
Understanding the effectiveness of CPR is crucial when making decisions about a DNR order. Cardiopulmonary resuscitation can be a violent and invasive procedure. While it may be appropriate and effective in certain situations—such as when a young, healthy person experiences sudden cardiac arrest due to a heart attack or accident—it is often unsuccessful in older patients or those with serious illnesses.
The success rate of CPR near the end of life is extremely low. Many people do not realize that even when CPR is “successful” in restarting the heart, it often results in broken ribs, internal injuries, and extended time in an intensive care unit with mechanical ventilation. For patients with advanced illnesses or those nearing the end of life, CPR may simply prolong suffering without meaningfully extending life or improving quality of life.
Who Should Consider a DNR Order?
A DNR order may be appropriate for various individuals, depending on their health status, values, and preferences. These include:
- Patients with terminal illnesses: Those diagnosed with conditions like advanced cancer, end-stage heart or lung disease, or progressive neurological diseases
- Elderly patients: Older adults who have discussed their end-of-life preferences with their healthcare providers
- Patients with serious chronic conditions: Those with multiple comorbidities or significant functional decline
- Patients who are permanently unconscious: Individuals in persistent vegetative states
- Anyone who values quality of life over quantity: Individuals who prioritize comfort and dignity over aggressive interventions
Importantly, DNR orders are not limited to elderly or terminally ill patients. Any adult, regardless of current health status, can have a DNR order if they choose. The decision should be based on personal values, religious beliefs, and preferences for end-of-life care rather than age or current health conditions alone.
Types of DNR Orders and Programs
Different jurisdictions and healthcare settings may have variations in DNR orders. Understanding the specific types available in your area is important:
Hospital DNR Orders
These are DNR orders written while a patient is hospitalized. A physician or other authorized healthcare professional writes the order after discussing the patient’s wishes with them or their surrogate decision-makers. The order is then placed in the patient’s medical chart for all healthcare staff to see.
Out-of-Hospital DNR Orders
An out-of-hospital DNR order is a written order issued by a patient’s attending physician that directs emergency medical services (EMS) providers to withhold CPR in the event of cardiac or respiratory arrest. This is particularly important because without such an order, EMS personnel are typically required by law to attempt resuscitation.
Durable DNR Orders
A durable do-not-resuscitate order remains valid across different healthcare settings and remains in effect even if the patient loses the capacity to make medical decisions. These portable orders ensure consistency in your care whether you’re at home, in a hospital, or in a long-term care facility.
POLST Programs
Physician Orders for Life-Sustaining Treatment (POLST) programs involve a professional-initiated discussion and shared decision-making process with people with advanced or end-stage illness. POLST results in a portable set of medical orders consistent with a person’s goals of care. POLST programs address not only CPR preferences but also the overall level of medical intervention wanted—ranging from full treatment to comfort care only, or some intermediate level—and whether to seek or avoid hospitalization.
How to Create a DNR Order
Step-by-Step Process
Creating a DNR order involves several important steps:
- Have a conversation with your healthcare provider: Discuss your health status, prognosis, values, and preferences regarding end-of-life care. This conversation should include your physician or, in some states, a nurse practitioner or physician assistant.
- Ensure you have decision-making capacity: You must be mentally competent to make this decision. If you lack capacity, a legal surrogate (such as a spouse, parent, adult child, or court-appointed guardian) may make the decision on your behalf.
- Discuss with family and loved ones: Share your wishes with family members and anyone you’ve designated as a healthcare proxy or agent.
- Request the DNR order in writing: Ask your healthcare provider to write and sign the DNR order. The physician should document the medical indication (such as an end-stage medical condition or permanent unconsciousness) and the discussion that took place.
- Ensure the order is accessible: For hospital settings, the order should be placed prominently in your medical chart. For out-of-hospital settings, keep a copy with you and inform emergency contacts about its location.
- Review and update as needed: Your wishes may change over time. Review your DNR order periodically and update it if your preferences or health status change significantly.
Legal and Medical Requirements
The legal requirements for DNR orders vary by state and jurisdiction, but certain principles are generally consistent:
- Written authorization: A DNR order must typically be in writing, though some jurisdictions allow oral orders in specific circumstances
- Physician signature: In most jurisdictions, only a physician (MD or DO) can write a DNR order, though some states allow nurse practitioners or physician assistants to do so after appropriate discussions
- Medical indication: The physician must document a medical reason for the DNR, such as an end-stage condition, terminal illness, or permanent unconsciousness
- Patient capacity or surrogate consent: The patient must have decision-making capacity and consent to the order, or a legal surrogate must consent on the patient’s behalf
- Documentation: The physician should document the conversation about the DNR and the patient’s reasoning in the medical record
DNR Orders vs. Other Advance Directives
| Characteristic | DNR Order | Living Will | Healthcare Power of Attorney |
|---|---|---|---|
| Who Creates It | Physician after discussion with patient | Patient (optionally with attorney) | Patient (optionally with attorney) |
| Type of Document | Medical order | Legal advance directive | Legal advance directive |
| When It Becomes Effective | Immediately upon execution; operative only during cardiac/respiratory arrest | Only when specific conditions are met (e.g., terminal illness, permanent unconsciousness) | Immediately upon execution or when patient lacks capacity (depending on type) |
| Scope of Decisions | CPR only | Multiple end-of-life decisions (CPR, ventilation, feeding tubes, etc.) | Any healthcare decision the surrogate deems appropriate |
| Medical Intervention | Specific medical order | Expressions of preferences and values | Authority to make decisions |
A key distinction is that a DNR order is a medical order issued by a physician, while a living will is a legal document expressing preferences. If a patient’s preference to forgo CPR is expressed only in a living will without a separate DNR order, CPR will be withheld only when a physician has determined that the patient lacks competence and has certified in writing that the patient has an end-stage condition or is permanently unconscious. Without such physician determination and certification or without a DNR order itself, the patient’s expressed preference for withholding CPR may not be sufficient. This is why having an actual DNR order is important—it is not subject to the preconditions imposed by living will laws.
Common Misconceptions About DNR Orders
Surveys have shown that only about one-third of patients correctly understand the meaning of a DNR order. Two-thirds do not realize that a DNR order will result in not being resuscitated even if the cause of cardiac or respiratory arrest is potentially reversible. Common misconceptions include:
- “DNR means do not treat”: This is false. DNR specifically addresses CPR only, not other treatments
- “A DNR order means the patient will die sooner”: DNR orders do not hasten death; they prevent interventions that may be inappropriate or unwanted
- “Only dying patients need DNR orders”: Any adult can have a DNR if they choose, regardless of health status
- “A DNR order prevents pain relief”: Pain management and palliative care continue with a DNR order in place
- “DNR orders are permanent”: Patients or their surrogates can revoke a DNR order at any time if they change their mind
Discussing DNR Orders With Your Healthcare Provider
Having a thoughtful conversation with your healthcare provider about DNR orders is essential. Consider asking:
- What is my current health status and prognosis?
- What is the likelihood that CPR would be successful if my heart or breathing stopped?
- What would happen if I have a DNR order but my condition changes?
- How is a DNR order different from other advance directives?
- Can I change or revoke a DNR order later?
- What are the legal requirements for DNR orders in my state?
- If I don’t have a DNR order, what will happen if my heart or breathing stops?
Frequently Asked Questions About DNR Orders
Q: Can I have a DNR order if I’m not terminally ill?
A: Yes. While many people with terminal illnesses have DNR orders, anyone of legal age and decision-making capacity can request one based on their personal values and preferences regarding end-of-life care.
Q: What happens if I don’t have a DNR order and my heart stops?
A: Without a DNR order, healthcare providers are typically required to attempt CPR if your heart or breathing stops. This is the legal default in most jurisdictions.
Q: Can my family override my DNR order?
A: Generally, no. If you have decision-making capacity and have properly executed a DNR order, your wishes take precedence. However, this can vary by jurisdiction, so it’s important to understand your local laws.
Q: Can I change my mind about a DNR order?
A: Yes, absolutely. You can revoke a DNR order at any time if your preferences change. Simply inform your healthcare provider, and they will remove the order from your medical record.
Q: Does a DNR order affect my ability to receive emergency care?
A: A DNR order only affects CPR and related resuscitative measures. You will still receive emergency care and treatment for other conditions, pain management, and comfort measures.
Q: Do I need an attorney to create a DNR order?
A: No. A DNR order is a medical order written by your physician or other authorized healthcare provider. While you may consult an attorney if you have questions about your overall advance care planning, an attorney is not required to create a DNR order.
References
- Do-Not-Resuscitate (DNR) Orders — Merck Manuals. 2025. https://www.merckmanuals.com/home/fundamentals/legal-and-ethical-issues/do-not-resuscitate-dnr-orders
- Do-Not-Resuscitate Orders (DNR) — Cleveland Clinic. 2025. https://my.clevelandclinic.org/health/articles/8866-do-not-resuscitate-orders
- Definition of do not resuscitate order — National Cancer Institute. 2025. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/do-not-resuscitate-order
- What is a Do Not Resuscitate (DNR) Order? — Saint Joseph’s University. 2025. https://www.sju.edu/centers/icb/blog/what-is-a-do-not-resuscitate-dnr-order
- Durable Do Not Resuscitate Program — Virginia Department of Health. 2025. https://www.vdh.virginia.gov/emergency-medical-services/other-ems-programs-and-links/durable-do-not-resuscitate-program/
- Do-Not-Resuscitate (DNR) — Ohio Department of Health. 2025. https://odh.ohio.gov/know-our-programs/do-not-resuscitate-comfort-care/donotresuscitatednr
- Do not resuscitate — Wikipedia. 2025. https://en.wikipedia.org/wiki/Do_not_resuscitate
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