Do-Not-Resuscitate (DNR)

What is a do-not-resuscitate order?

A do-not-resuscitate (DNR) order is a type of advance directive. Having a DNR order means you don’t want treatments like cardiopulmonary resuscitation (CPR) used on you if your heart or breathing stops.

Under ordinary circumstances, healthcare providers will do everything they can to try to save your life. That can include CPR and other treatments like:

• Intubation and putting you on a ventilator (mechanical ventilation)
• Using a defibrillator to try and “shock” your heart into a normal rhythm

But what if you’re already very sick or have a terminal illness? That’s where DNR orders come in. They can help if you want any of the following:

• To limit any pain or suffering you have as you near death
• To preserve your dignity at the end of your life

A healthcare provider usually writes a DNR order after a discussion with you and/or any legal decision-makers or loved ones you want present. Depending on the law where you live, a DNR is only valid if written by a physician (MD or DO) or another specified type of healthcare professional.

Ideally, you’d have a do-not-resuscitate order prepared before an emergency happens. The order tells healthcare providers not to try CPR if your heart stops beating or your breathing stops. The provider who writes the order adds it to your medical chart for other medical professionals to see.

What are the types of DNR?

Most of the time, a DNR refers to CPR and related treatments like using a defibrillator. But there are other, similar orders that are more specific. And sometimes, the law where you live can affect the types of available DNRs. Some examples of different DNR types include:

• Do not attempt resuscitation (DNAR). This is basically the same as a DNR. But some places or healthcare organizations use this term instead.
• Allow Natural Death (AND). This lets providers use treatments that keep you as comfortable as possible. The goal here is to prevent suffering as you die.
• Do not intubate (DNI). This lets providers know you wouldn’t want placement of a breathing tube or to be on a ventilator if you can’t breathe on your own.
• Specified DNRs. These are tailored DNRs. For example, you might specify that you don’t want CPR. But healthcare providers can still use other treatments, like a defibrillator, to try to save your life.
• Comfort care orders. These may specify what kind of care providers can use near the end of your life. They also communicate your wishes in the context of keeping you as comfortable as possible as your life ends.

There might be other variants or types of DNRs available depending on where you live and your situation. Your healthcare provider can tell you more about your options.

If CPR saves lives, why would anyone want a DNR order?

Some people with terminal illnesses or serious medical conditions might not want to undergo CPR, even if that means they might die as a result. Deciding to have a DNR order can empower you by making you feel more in control of your own life.

Although CPR can save lives, it isn’t 100% successful. And for people who are very sick or have certain conditions, the odds of success can be much lower. It’s also common to have painful injuries from CPR, like broken ribs and sternum fractures.

How do I make my wishes known about a DNR?

Talk to your primary care provider or the main provider leading your care team. Your healthcare provider will discuss the benefits and risks of CPR and related types of care. This is meant to be a frank conversation with you about what exactly you want. Informed consent is vital in these conversations so you can make a choice based on all the facts and your personal preferences. And if you need to think about it or talk about it further with loved ones, it’s okay to tell your provider that. It’s also common for healthcare providers to ask about a DNR order during office visits or when you’re admitted to the hospital.

Once you have a DNR, your provider can file it with your medical record. They can also give you a copy to carry with you. You can also find wearable medical ID bracelets that notify first responders that you have a DNR.

What if I can’t make the decision about a DNR myself?

If you’re unconscious due to an illness or injury, or unable to make an informed decision for any other reason, you won’t be able to state your wishes about a DNR. If you already have a DNR and it’s in your medical record, your loved ones can’t override it.

If you don’t yet have a DNR, you may name someone to speak for you, such as your power of attorney or other healthcare proxy. If you haven’t named a healthcare proxy, a family member can sometimes make medical decisions for you when you’re not able to make decisions yourself. Which family members can make decisions for you varies by state.

What if I change my mind after a DNR order is written for me?

You always have the right to change your mind with regard to your DNR. If you do change your mind, tell your healthcare provider immediately so they can note the change in your medical record. You should also stop carrying any wearable items like ID bracelets and destroy any paper copies you have.

Tell your loved ones and other caregivers that you’ve changed your mind and your DNR is no longer what you want.

What happens if you resuscitate a DNR patient?

DNR orders only apply to medical professionals who know (or should reasonably know) about it. If a healthcare provider doesn’t know about your DNR or there’s a miscommunication, they won’t necessarily get into trouble.

But if your healthcare provider resuscitates you and they know about your DNR, they can face legal consequences. They can also face consequences if they don’t know about your DNR due to negligence.

Nonmedical professionals can’t get into any kind of legal trouble for performing CPR on a person with a DNR. If you’re trained in CPR, you should attempt it on a person experiencing cardiac arrest. But if a situation arises where you know that the person has a DNR, you should respect their wishes not to be resuscitated.

How does a DNR affect my care if I’m having surgery?

If you have a DNR and need to undergo surgery, be sure to talk about your DNR with your surgeon and your anesthesiologist. They can tell you more about how your DNR might affect any part of your surgery or procedure.

In some cases, your anesthesiologist, surgeon or both may ask you to suspend your DNR during your surgery. That’s because some of the routine parts of surgery, especially general anesthesia, might conflict with your DNR. If you have any questions about this, don’t hesitate to ask your surgeon or anesthesiologist. Making sure they understand your concerns is a vital part of making sure you get care that aligns with your needs and wishes.