Do-Not-Resuscitate (DNR)

What is a do-not-resuscitate order?

A do-not-resuscitate (DNR) order is a legal document that means a person has decided not to have cardiopulmonary resuscitation (CPR) attempted on them if their heart or breathing stops. People who choose to have a DNR usually have a terminal illness or other serious medical condition. In most situations, a healthcare provider writes a DNR order after discussing the benefits and risks of CPR with the person, their loved ones or their legal decision-maker.

Ideally, someone would fill out a do-not-resuscitate form before an emergency occurs. A DNR order allows them to choose not to receive CPR in an emergency. The DNR order informs healthcare providers not to perform CPR if a person’s heart stops beating or their breathing stops.

When you have a DNR, it becomes part of your medical chart. Sometimes, a DNR order is called a do-not-attempt-resuscitation order or an allow-natural-death (AND) order. If you go to the hospital, it may help to post your DNR order next to your hospital bed to avoid any confusion during an emergency. Without a DNR order, medical staff at the hospital will make every effort to restore your breathing and the normal rhythm of your heart.

What is cardiopulmonary resuscitation?

Cardiopulmonary resuscitation (CPR) is a life-saving procedure you can perform on a person if their heart stops beating or their breathing stops. It usually involves mouth-to-mouth breathing or chest compressions. Immediate CPR can greatly increase a person’s chances of survival after cardiac arrest.

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

Cardiopulmonary resuscitation often means more than chest compressions and mouth-to-mouth breathing. CPR might also include the use of powerful drugs or electric shock with an automated external defibrillator (AED) to get the heart beating again. Healthcare providers sometimes insert a breathing tube into your airway (trachea) to help you breathe.

Although CPR can save lives, it sometimes doesn’t work. Even if a person is resuscitated, they may suffer painful injuries during CPR, such as broken ribs and sternal fractures.

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

What is fluid resuscitation?

Healthcare providers use fluid resuscitation to deliver fluids and electrolytes into your body. If you’ve experienced a traumatic injury and/or you’re going into shock, your body needs fluids to function. This helps your body carry oxygen to your vital organs.

Do-not-resuscitate orders don’t cover fluid resuscitation. They specifically direct providers not to perform CPR. Instructions for other treatments — including fluid resuscitation, pain medication and nutrition — aren’t included in DNRs.

How do I make my wishes known about CPR?

Talk to your doctor or another healthcare provider if you want a DNR order. Your provider can fill out the form for the DNR order. They’ll put it in your medical record if you’re in the hospital. Your provider can also help you get a bracelet, wallet card or other DNR identification to have at home and when you’re not in the hospital. You may also be able to request a do-not-resuscitate form from your state’s Department of Health.

Make sure to include your wishes in a living will or an advance care directive. Tell your healthcare proxy (healthcare agent) and your family of your decision. Your healthcare proxy can agree to a DNR order for you.

What if I can’t make the decision about getting CPR myself?

If you’re unconscious due to an illness or injury, you won’t be able to state your wishes about wanting CPR or not. If you already have a DNR and your doctor has it on file, 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 healthcare proxy. If you haven’t named a healthcare proxy, a family member can sometimes make medical decisions for you, but only when you’re not able to make decisions yourself.

What happens if you resuscitate a DNR patient?

DNR orders only apply to medical professionals. If your doctor or another healthcare provider knows about your DNR and resuscitates you anyway, they can face legal consequences. However, these legal concerns are complex. If the provider isn’t aware of a DNR or there’s a miscommunication, they won’t necessarily get into trouble.

In some states, DNR orders are only valid at the hospital. Outside of a hospital, DNRs don’t apply. This means, for instance, that an EMS worker can legally administer CPR even if a person has a DNR.

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.

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

You always have the right to change your mind and request that CPR be performed on you during a medical emergency. Tell your healthcare provider immediately so they can start the process to revoke your DNR order. You should destroy all DNR forms and identification that your provider gave you or that you’re wearing. Inform your loved ones and other caregivers that you’ve changed your mind and no longer want a DNR.

A note from Cleveland Clinic

Having a conversation with your loved ones and healthcare providers about a do-not-resuscitate order can be challenging, but it’s necessary to make sure everyone knows what you want to happen to you in a medical emergency. These can be difficult choices for you and your loved ones to make. And there are no hard and fast rules about what you should choose. But it’s important to think about these issues while you’re still able to make these decisions for yourself.