DNR Meaning
You might have heard of the term DNR, but what does DNR mean? Do you want a DNR order? What could happen if a loved one has a DNR order? Learn more about these important advance directives and what they might mean for you and your loved ones.
What Does DNR Stand For?
The literal meaning of DNR is do not resuscitate. It instructs healthcare providers not to resuscitate the person for whom the DNR order is in place.
What Does DNR Mean?
A do-not-resuscitate order is a medical order that a physician has signed that states the patient’s wishes not to be resuscitated in case of an emergency, such as if they stop breathing or their heart stops. A patient with a physician order to DNR should not be resuscitated by medical professionals, including emergency medical service (EMS) providers.
A DNR is part of advance care planning, which provides details about a patient’s wishes and the end-of-life care they want to receive.
What Is a DNR in Medical Terms?
When a DNR order is in place, this expresses the patient’s preference to die of a natural death, one without medical intervention. A DNR order instructs medical professionals not to provide cardiopulmonary resuscitation (CPR) to a patient. CP refers to any of the following:
- Using chest compressions, electric shock, or medications to restart the heart
- Mouth-to-mouth breathing (in the case of out-of-hospital CPR)
- Intubation in which a breathing tube is inserted into the patient’s throat to create a clear airway and attaches to a ventilator to assist with breathing
Why Would Someone Have a DNR?
People with a do not resuscitate order often have a medical condition that would make it unlikely that they would be able to recover after CPR. Other common reasons people request a DNR order include they have one of the following:
- A terminal illness and have a short time left to live
- A serious chronic medical condition
- A medical condition that involves increased dependence on others for activities of daily living and a low quality of life
- A condition that qualifies them for hospice care when death is imminent
It is not necessary to have any of the above conditions to request a DNR order. Any adult can request a do-not-resuscitate order.
What Is a DNR Patient?
A DNR patient is someone who has a DNR order in their medical records. They should not be resuscitated in case of an emergency.
How to Create a Do Not Resuscitate Order
A DNR order can be created in various ways. It is best to have a DNR order in place before an emergency arises. Often, a patient discusses their wishes with their doctor, health care proxy, or family members and then the physician prepares the order. If the patient is at the hospital, the doctor includes the DNR order in the patient’s medical record.
In other situations, a DNR order might be part of a hospice care plan. This type of plan may include other information about palliative care, which is comfort care provided at the end of life.
Another way to indicate your preference for not resuscitating is to include it in your living will or other advance directive (discussed below).
Other ways to communicate your wishes is to carry a DNR instruction in your wallet or to wear a special bracelet made for this purpose.
Some jurisdictions keep standard forms at the state Department of Health.
Making the Decision for Someone Else
In some situations, the patient loses their decision-making ability. The patient’s health care proxy can agree to a DNR order for the patient. If a DNR order is already in place, family members cannot override it.
Do All States Acknowledge Do Not Resuscitate Orders?
Yes. All states allow DNR orders, but there are differences in state laws. For example, some states allow nurse practitioners or physician associates to sign these medical orders. Some states use other names for DNR orders such as a no code order, allow natural death order, or a do not attempt resuscitation order. Some states require a notary or two witnesses to observe the signing of a DNR order.
When Are DNR Orders Not Followed?
There are some times when medical providers might not follow a DNR order, such as:
- The DNR order is not in writing
- Health care providers cannot find or confirm the DNR order
- The medical provider does not know if the DNR is valid
- Breathing or the heart has stopped because of an unnatural cause, such as an obstruction in the airway
Can the Family Ignore the DNR Order?
No. Family members cannot ignore these physician orders. Medical providers are required to honor your wishes, once you have made them known.
Can the Family Revoke the DNR Order?
Family members generally cannot revoke the DNR order unless they were named as the patient’s agent in a health care power of attorney and doing so is in line with the patient’s wishes.
Can You Change Your Mind About a DNR?
Yes. As long as you still have the mental capacity to make health care decisions, you can change your mind about DNR. You can request you receive CPR. However, if you change your mind, you should inform your health care team so that your preference and medical records can be updated.
Other Types of Advance Directives
An advance healthcare directive is a legal document that provides details about a patient’s wishes and medical decisions ahead of time. It can help communicate the patient’s wishes in case they are not able to communicate them because of a medical crisis.
A do-not-resuscitate order is only one type of advance directive. Other common forms of health care directives include:
Living Will
A living will is a document that specifies the type of medical care a person wants to receive at certain times, such as if they have a terminal illness or are permanently unconscious. It lays out medical decisions ahead of time, such as:
- Whether they want to receive life-sustaining treatment
- Specific medical treatment they want or don’t want to receive, such as:
- Artificial hydration or feeding tubes
- Breathing tubes
- Treatment for new conditions
- Antibiotics and other medications to treat new conditions
- Dialysis
- Blood transfusions
- The quality of life you consider unacceptable to sustain your life
Some states require that two physicians confirm that the patient can no longer make medical decisions before they can allow the living will to guide their health care.
Medical Power of Attorney
A medical power of attorney (POA) or health care proxy is a legal document that gives someone else the right to make medical decisions on your behalf. This person generally has the right to:
- Talk to the patient’s caregivers
- Review the patient’s medical records
- Make medical decisions for the patient consistent with their wishes and values
- Have the patient admitted or discharged from a medical facility or nursing home
- Agree to or refuse specific medical treatments for the patient
POLST
A POLST is a portable medical order. It provides instructions for all health care professionals and includes instructions beyond a DNR instruction. A POLST may provide information about:
- Whether CPR should be attempted
- Whether a patient wants to remain at home or go to a medical facility
- Specific medical treatments they want or do not want to receive
- The type of health care plan they want to have followed
Here is a quick comparison of the various options for advance care planning:
| DNR Order | POLST | Healthcare POA | Living Will | |
| Who prepares? | Physician | Patient | Patient | Patient |
| Do emergency responders follow instructions? | Yes | Yes | No | No |
| Gives someone else the right to make decisions for you? | No | No | Yes | No |
| Expresses whether you want CPR | Yes | Yes | Maybe | Yes |
| Explains your preferences for other medical treatment? | No | Yes | Maybe | Yes |
| Gives someone else a right to consult with your health care professionals? | No | No | Yes | No |