A DNR (Do Not Resuscitate) order is a medical directive that instructs medical personnel not to resuscitate a person in the event of cardiac or respiratory arrest.
In other words. If you have a DNR order in place, your medical team will let you die naturally if your heart stops or you stop breathing.
It’s important for patients and family members to know that DNR orders are different from Advance Directives, which are legal documents that outline a person ‘s wishes for medical care if they are unable to make decisions for themselves.
A DNR order is a specific instruction that tells your medical team not to perform CPR (cardiopulmonary resuscitation) or other resuscitation measures, while an Advance Directive may say that you do not want to be resuscitated but it does not have to specify which measures should not be taken.
Remember, a DNR order is personal and should reflect your own wishes and values. It should be a part of other legal documents, such as a health care power of attorney, living will, etc.
One recommendation that we have for anyone who signs a DNR is to display it somewhere in your home that is readily visible. Emergency personnel are trained to look at the refrigerator first.
You can also attach a Vial of Life Program form with that DNR which would give first responders more information.
Some people take the extra step and get a tattoo on their chest that reads “Do NOT Resuscitate”.
Of course, this is not legally binding but it can stop a medical team long enough to check for the legal paperwork of a proper DNR.
What Does A DNR Order Actually Mean?
A DNR order means that you do not want any type of resuscitation if you happen to experience cardiac arrest or your breathing stops.
This includes CPR, chest compressions, use of a defibrillator, and use of medication to restart your heart.
It is important to remember that this is just for cases where you stop breathing or your heart stops beating – it does not apply to other medical procedures.
The goal of a DNR is to provide health care providers with instructions on medical treatments that they should provide to you during an emergency.
A secondary goal of a DNR is to give the patient control over their end of life care decisions.
For some individuals, a natural death is preferable over an extended hospital stay with numerous medical interventions.
Why Would Someone Have A DNR Order?
DNR orders are usually given to people who are terminally ill or very old and frail, and who would not survive CPR or other life-saving measures.
Many people choose to have a DNR order in place because they do not want to undergo the pain and suffering of aggressive medical interventions.
Others may choose a DNR order because they do not want to be kept alive on life support if there is no hope for recovery.
It’s important to discuss your wishes with your loved ones and healthcare proxy before a medical emergency arises.
This way, they will know what you want and can make sure your wishes are followed if you are unable to communicate them yourself.
Can You Change Your Mind On A DNR?
It’s important to remember that a DNR order is not set in stone. If your situation changes and you would like to be resuscitated, you can always change your mind.
Your medical team will be happy to help you make the necessary changes to your order.
How Long Does A DNR Order Last?
A DNR order is usually in place until the patient’s death or until the order is revoked by the patient or their surrogate decision-maker.
In some cases, a DNR order may be temporary and put in place during a crisis, such as during a heart attack. Once the crisis has passed, the DNR order can be removed.
It’s important to keep in mind that a DNR order is not a “do not treat” order. You will still receive palliative care, which includes measures to keep you comfortable and relieve pain.
What Is Palliative Care?
The purpose of palliative care is to relieve suffering and improve the quality of life for people with serious illnesses.
Palliative care teams work with you, your family, and your other caregivers to help you manage your symptoms, pain, and stress.
Palliative care can be given at any stage of a serious illness and can be provided along with curative treatment.
Palliative care does not include any treatment that would resuscitate you or prolong your life.
What Are Some Examples Of Palliative Care?
Palliative care may include measures to control pain, manage symptoms such as nausea and shortness of breath, provide psychological and spiritual support, and help you and your family make decisions about your care.
Palliative care teams may also help you arrange for hospice care if you choose it.
What Is Hospice Care?
Hospice care is a type of palliative care that provides specialized care to people who are in the last stages of a serious illness.
Hospice care is available as either inpatient or outpatient care.
Inpatient hospice care is provided in a hospice facility, and outpatient hospice care is provided in the person’s home.
Hospice care focuses on providing comfort and support, rather than trying to cure the illness.
For more information about hospice and their services, read our article on When To Call Hospice For Elderly Care.
What Are The Different Types Of DNR Orders?
There are two types of DNR orders:
1. DNR Comfort Care – also called DNRCC. This type of order means that if your breathing or heartbeat stops, medical personnel will not revive you. They will only provide comfort care, which includes measures to keep you comfortable and free of pain.
2. DNR Comfort Care Arrest – also called DNRCC-Arrest. This type of order allows the use of life-saving tactics before the person’s breathing or heartbeat stops. But if they do stop breathing or their heart stops, they will only be provided comfort care.
There are also separate programs that some states have adopted which incorporate a DNR. These states therefore do not have separate DNR forms.
Let me explain what each of these programs are.
POLST – The Physician Orders for Life Sustaining Treatment
(POLST) is a form that you and your doctor fill out together. It becomes a part of your medical record and is honored by emergency medical personnel and hospitals.
MOLST – The Medical Orders for Life Sustaining Treatment
(MOLST) is very similar to the POLST, but it is used in states without a POLST program.
MOST – A Medical Order for Scope of Treatment
(MOST) is also similar to the POLST and MOLST, but is used in states with a POLST program.
All of these programs have the same intention. They give the patient the choice to decide what type of treatment they want to be provided with during their care.
This is given to patients who present with a serious medical condition or they are seriously ill or medically frail.
Much like a DNR, signing any one of these forms will tell the medical team that you do not want heroic intervention such as CPR, Dialysis, Tube Feeding, Intubation, etc. to extend your life.
The Pros And Cons Of A DNR
Making the decision to sign a do not resuscitate (DNR) order can be difficult. Not only for the person signing it, but for their family members as well.
It’s important to understand the pros and cons of making this decision so that you can make an informed choice.
Pros of Signing a DNR
One of the key benefits of signing a DNR is that it allows you to have some control over your care when you are unable to communicate your wishes.
If you are in a situation where resuscitation would be ineffective or cause more harm than good, having a DNR in place can ensure that your wishes are respected and that you receive the care that is right for you.
Another benefit of signing a DNR is that it can give family members peace of mind knowing that their loved one will be taken care of in accordance with their wishes.
With a DNR, family members can also be more certain that the patient is not receiving treatments or interventions which are not necessary for their condition.
Cons of Signing a DNR
Family members may oppose the DNR although legally they may not have any choice but to accept it. Still, this could cause disagreements and arguments.
Signing a Do Not Resuscitate order could mean that the patient will not get the chance to try other treatments.
But of course, most DNR’s are signed at a time when the patient is terminal or very old and frail.
Do Not Resuscitate Laws By State (In The USA)
Here is a summary of the DNR orders for each state within the USA.
Remember, a DNR order is an important decision that should not be made lightly. It is a good idea to discuss your wishes with your family and physician ahead of time.
In Alabama, a DNR order must be in place before CPR can be withheld. The DNR order form allows a patient to avoid treatment should their heart or brain show no electrical activity.
The order must be signed by the patient or their legal representative, and it must be witnessed by two other people.
For more information about dnr orders in Alabama, you can visit the Department of Public Health website.
The Alaska Department of Health and Social Services has a few different DNR rules for patients in the state.
For adults, a DNR order can be put into place either through a signed form or by having it noted in the medical chart.
For more information about DNR orders in Alaska, you can visit the Department of Health and Social Services website.
In Arizona, a DNR order must be printed with an orange background. In addition, the patient must also wear an orange-colored wrist or ankle band.
A physician does not have to sign it, instead any licensed healthcare provider can sign it. It must be witnessed by at least one adult OR a notary public.
For more information about DNR orders in Arizona, you can visit the Department of Health website.
In Arkansas, a DNR order must be signed by the patient or their legal representative and a physician.
For more information about DNR orders in Arkansas, you can visit the Department of Health website.
In California, a DNR order must be signed by the patient or their legal representative and a physician.
For more information about DNR orders in California, you can visit the Department of Health website.
In Colorado, the DNR order must be written and signed by the patient’s doctor. No witness is required.
For more information about DNR orders in Colorado, you can visit the Department of Health website
In Connecticut, a DNR order must be signed by the patient (or their legal guardian) and must be witnessed by at least two people and notarized.
For more information about DNR orders in Connecticut, you can visit the Department of Health website.
In Delaware, a DNR order must be signed by the patient (or their legal guardian) and witnessed by 2 individuals 18 years or older.
For more information about DNR orders in Delaware, you can visit the Department of Health website.
In Florida, a DNR order must be signed by the patient or their legal representative or a health care proxy and the patient’s physician. In Florida, a DNR is a doctor’s order.
For more information about DNR orders in Florida, you can visit the Department of Health website.
In Georgia, a DNR order must be signed by the patient or their legal representative, signed by a physician and must be witnessed by two other people.
For more information about DNR orders in Georgia, you can visit the Department of Community Health website.
In Hawaii, a DNR order is a clause that is part of the state’s POLST (Provider Orders for Life-Sustaining Treatment) form.
The POLST form needs to be signed by the patient or their surrogate and a physician.
For more information about DNR orders in Hawaii, you can visit the Department of Health website.
In Idaho, a DNR order needs to be signed by the patient or their legal representative and a physician. Wearable devices are provided if requested.
For more information about DNR orders in Idaho, you can visit the Department of Health and Welfare website.
In Illinois, a DNR order has to be signed by the patient or their legal representative and a physician. A DNR is a physician’s order in Illinois.
For more information about DNR orders in Illinois, you can visit the Department of Public Health website.
In Indiana, a DNR order may be signed by the patient or their surrogate and a physician as well.
For more information about DNR orders in Indiana, you can visit the Indiana State Department of Health website.
In Iowa, a DNR order is initiated by the patient’s physician.
For more information about DNR orders in Iowa, you can visit the Iowa Department of Public Health website.
In Kansas, a DNR order for a patient must be signed by the patient (or a surrogate) and a physician. It must also be witnessed as well.
In Kentucky, there are two forms that can be used for end of life decisions. A MOST (Medical Orders for Scope of Treatment) form or a DNR form. A physician initiates either form and they must also sign it as well as the patient or their surrogate.
In Louisiana, the DNR is included in the LaPost (Louisiana Physician Orders for Scope of Treatment) form.
In the state of Maine, a DNR order must be in writing and signed by the person who has the DNR order, by that person’s legal guardian and their physician.
In Maryland, a DNR is integrated in the Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form.
Several options are provided and we recommend that you speak with your physician about these. The MOLST form must be signed by a physician nurse practitioner or a physician’s assistant.
In Massachusetts, the DNR order is integrated in their Massachusetts Medical Orders for Life Sustaining Treatment (MOLST) and Comfort Care form.
This must be signed by the patient (or a legal guardian) as well as a physician. It will then be printed on colorful paper. This makes it very easy to identify.
In Michigan, a DNR order must signed by both the patient and their attending physician.
If you have any questions about DNR orders in Michigan, visit the Michigan Department of Health & Human Services.
In Minnesota, like many other states, the DNR is integrated with the Minnesota POLST form. It’s to be signed by a physician and the patient.
In Mississippi, the DNR is meshed with their Physician Order for Sustaining Treatment (POST) form and like many other states, it must be signed by both the patient and their attending physician.
In Missouri, there are different DNR forms for patients in a hospital and those outside of a hospital. But both set have to be signed by the patient and a physician.
Montana also has their DNR integrated with their POLST document. The patient (or their representative) and a physician must sign the form.
In Nebraska, a DNR order must be filled out and signed by the patient (or legal guardian), a physician and must be witnessed by at least one person over the age of 18.
In Nevada, both the patient and their attending physician must sign the DNR form.
New Hampshire law has what they call a P-DNR (Portable Do Not Resuscitate) order form. This form must be readily available for emergency responders.
The order, like in other states must be signed by a physician or nurse practitioner and the patient or their surrogate.
In New Jersey, a patient can sign a DNR or a DNRO. The difference with a DNRO is that the patient does not have to be terminally ill.
Still the forms must be signed by the patient and their attending physician.
Here is a link to the guidelines for DNR orders in the state of New Jersey.
New Mexico does have DNR laws in the books and the order is signed by both the patient and their physician or a physician’s designee.
In New York, a DNR order must be signed by a physician, nurse practitioner, or physician assistant and witnessed by two adults over the age of 18. The patient is not required to sign the form.
In North Carolina, a DNR order is included in their state’s MOST form. This must be signed by the patient or their surrogate. Also, the attending physician and 2 adult witnesses over the age of 18 must also sign it.
In North Dakota, their DNR forms are included in the state’s POLST forms. They are only effective if signed by a physician, the patient and 2 adults over the age of 18 who are designated witnesses.
In Ohio, the patient does not have to sign the DNR form. Instead, the physician, physician assistant or Advanced practice registered nurses must sign the DNR.
In Oklahoma, the DNR form is signed by the patient or their representative. It must also be signed by two witnesses (18 years or older) and who are not in the patient’s will.
In Oregon, the DNR is included in the state’s POLST form. The law states that the DNR form is to be signed by the patient as well as an “authorized medical professional.”
The state of Pennsylvania has a simple DNR form that is to be signed by the patient or representative and the patient’s physician.
In Rhode Island, the DNR order is a part of the MOLST form. This is signed by the patient or surrogate and a physician or nurse practitioner.
Two cities in South Carolina integrate the DNR into the POST program. Otherwise, the remainder of the state uses a stand alone DNR Form.
Whichever form is offered where you live in South Carolina, both the patient (or surrogate) and the physician must sign the form.
In South Dakota, the DNR forms are integrated into the MOST program. The patient or their representative as well as either a physician, nurse practitioner or a physician’s assistant must sign the form.
The state of Tennessee adopted the POST program so their DNR is incorporated into this form.
The patient or their representative as well as a qualified health professional must sign this form. Tennessee deems a qualified health professional as a physician, a nurse practitioner, a physician assistant or a clinical nurse specialist.
In Texas, a DNR order must be witnessed by the medical staff before it can be enacted.
It must be signed by the patient or their surrogate, a physician and either 2 witnesses over the age of 18 or a 2nd physician.
In Utah, the DNR is now within their POLST program.
It must be signed by the patient or their representative as well as either a physician, a doctor of osteopath, a physician’s assistant or an advanced practice registered nurse.
In Vermont, the patient’s clinician must be consulted in the preparation of a DNR form.
The patient or surrogate must sign it as well as either a physician, doctor of osteopath, physician assistant or an advanced practice registered nurse.
Virginia law allows patients to have a DNR order in place.
It only requires the patient or representative and a physician to sign this form.
Washington law has implemented the POST program so the DNR is integrated into that form.
The patient or representative must sign this form as well as either a physician, a certified physician’s assistant, or an advanced practice registered nurse.
West Virginia participates in the POST program which has the DNR form.
The patient or surrogate as well as either a physician, a doctor of osteopath or an advanced practiced registered nurse must sign this form.
Speak to your physician about obtaining this form.
Wisconsin also has a simple DNR form and a DNR bracelet to help identify that the patient has signed this form.
Both the patient or surrogate and physician must sign this form.
Wyoming also has a simple DNR form that must be signed by the patient or surrogate and a physician.
Frequently Asked Questions
Does A DNR Order Apply To All Medical Procedures?
No – a DNR order applies specifically to cases where the patient has stopped breathing or their heart has stopped beating. In all other cases, medical professionals will still provide care and treatment per the patient’s wishes.
How Is A DNR Order Created?
The process for creating a DNR order varies from state to state, but generally the patient must fill out a form and have it signed by their doctor. The form will then be placed in the patient’s medical chart so that all healthcare providers are aware of the patient’s wishes.
What If A Patient Is Not Capable Of Making A Decision About A DNR Order?
If a patient is not able to make a decision about whether or not they want CPR, their family or a surrogate decision maker can make the decision for them. If there is no family available, the hospital’s medical team will make the call.
What Is A Surrogate Decision Maker?
A surrogate decision maker is someone who is legally allowed to make decisions on behalf of the patient, such as a family member or close friend. We recommend you speak with an elder law attorney about designating a surrogate for yourself or a loved one.
What Happens If I Don’t Have A DNR Order In Place?
If you do not have a DNR order in place and suffer a cardiac or respiratory arrest, your healthcare providers will attempt to revive you through CPR. However, if you are resuscitated, you may be left with significant physical and cognitive impairments.
How Can I Get A DNR Order?
In most states, you must be at least 18 years old to request a DNR order. You will need to fill out a form and have it signed by your doctor. Once the form is complete, you should keep it with you at all times in case you find yourself in need of medical services or in an emergency situation.
Do I Need A DNR If I Already Have A Living Will?
Yes – a living will is only one part of your advance care planning. A DNR order is specific to resuscitation and may be different from your wishes expressed in a living will.
Can A DNR Be Revoked By Family?
The answer to this is that it depends on what the laws are in your area. But, if the family disagrees with the DNR order, they can certainly speak to the physician in charge.
Can You Give Oxygen To A DNR Patient?
Yes. DNR does not mean that there is absolutely no medical treatment or assistance provided at all. The types of treatments that continue to be given include positioning the patient for comfort, treating blood loss, pain medication and more.
A DNR order is a document that states an individual’s wishes regarding CPR and other life-saving measures. This form must be signed by the patient or surrogate and physician in order to be valid.
Each state has different requirements for what needs to be included on the form, so it’s important to check with your state’s specific requirements.