DNR: What is a do-not-resuscitate order?

A DNR, or "do-not-resuscitate" order, can help to ensure your wishes are respected should your heart stop beating or you stop breathing.

What is a DNR?

A DNR designation informs health care providers not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating or if they stop breathing. However, it does not mean that all treatments are withheld. Patients with a DNR order still receive standard medical care, including pain management, medications, and other interventions as needed. Without a DNR order, medical staff will attempt every medical effort to restore your breathing and the normal rhythm of your heart.

A DNR order should be documented in a person's medical record and in certain legal documents. Most often, people first encounter a DNR order when they are admitted to the hospital. In the United States, every hospital requires documentation of a whether or not a person wishes to have medical staff initiate CPR if necessary.

If a DNR order is not placed in the person's medical record, then by default the hospital staff will immediately initiate CPR and attempt to revive the patient.

DNR decision-making

While the choice to create a DNR order is personal, it's always best to have your family aware of your decision. Most people who choose DNR status have evaluated their current quality of life, and whether ongoing medical therapies are likely to improve their symptoms or meaningfully prolong their life should their heartbeat or breathing suddenly stop.

Someone facing advanced illness, end-stage disease, or nearing the end of life might decide to create a DNR. You might consider a DNR if one or more of the following applies:

• You have a terminal or progressive illness.
• You prioritize comfort care over life-extending treatments.
• You are in hospice care, where the focus is on managing symptoms and improving quality of life.

In situations where you are not able to make your own decision around DNR status (for example, if you are unconscious or mentally incapacitated), your health care proxy can ask to have the order placed in your medical record. That's why it's important for you to discuss not only DNR choice, but also your wishes around other care you do and don't wish to have, should you become too ill to make your own decisions.

Anyone for any reason may decline to be resuscitated. However, if the person's medical providers, family, or close friends believe a decision to designate DNR is not well founded, attempts should be made to offer reasons why that choice should be reconsidered. For example, someone with major depression symptoms may state they don't want CPR should their heart stop. In that situation, the patient should be encouraged to pursue one of the many effective treatments for depression before having a DNR order placed in the person's medical record.

What else to know about DNR

Similar to any order a doctor places in the medical record, a patient or health care proxy can reverse a prior DNR order at any time. For example, during an emergency, if you are conscious and able to communicate, then your wishes supersede your DNR. If your preferences or circumstances shift outside of an emergency, you can revoke a DNR order. If you decide to reverse your DNR, inform your provider immediately so they can start the process to revoke it.

There are occasional circumstances when a doctor requires a temporary reversal of a DNR order, such as when a person needs surgery.

Patients may also make specific requests related to a DNR order. For example, a patient may wish to have chest compressions and an electric shock delivered to his or her heart, but never want to have a breathing tube inserted.