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Do-not-resuscitate order

No code; End-of-life; Do not resuscitate; Do not resuscitate order; DNR; DNR order

What it is

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.

A DNR order allows you to choose whether or not you want CPR before an emergency occurs. It is specific about CPR. It does not provide 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 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 not to prolong life, but to treat symptoms of 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 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.
  • If you are a patient in a hospital or nursing home, your doctor must agree to settle any disputes within 72 hours 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 non-hospital settings.
  • Standard forms may be available from your state's Department of Health.

Make sure to:

If you do change your mind, talk with your doctor 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 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, but only when:

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

References

Iverson KV, Heine CE. Bioethics. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:bonus online content.

Update Date: 5/7/2014

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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