How do you want your doctor or first responders to proceed if you stop breathing? Some people wish to be revived at all costs, while others prefer to continue into a natural death.
If you want to ensure medical professionals won’t revive you, create an official DNR form.
What Does Do Not Resuscitate (DNR) Order Meaning?
DNR stands for “Do Not Resuscitate.” It is a medical order that indicates a person’s preference not to receive cardiopulmonary resuscitation (CPR) if their heart or breathing stops. A DNR order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person’s heart or breathing stops.
It is usually requested by an individual or their legal representative and is typically written by a physician. The order is usually included in the person’s medical record and may also be displayed on a bracelet or other form of identification to alert healthcare providers.
Signing a DNR means you don’t want doctors or emergency personnel to perform CPR if you stop breathing or your heart stops beating.
Depending on your location, a DNR might also be known by one of the following names:
- Do Not Attempt Resuscitation (DNAR)
- Allow Natural Death (AND)
- Physician Orders for Life-Sustaining Treatment (POLST)
- Medical Orders for Life-Sustaining Treatment (MOLST)
Every state implements DNR laws, so understand your state’s requirements.
What Does Resuscitate Mean?
Resuscitation is using cardiopulmonary resuscitation (CPR) to correct a lack of breathing or heartbeat in an ill patient. CPR refers to the resuscitation of the heart via chest compressions and artificial ventilation.
Medical professionals are legally required to perform CPR to restart your heart and save your life — unless a DNR order has been issued.
Basic CPR techniques involve a series of aggressive chest compressions and mouth-to-mouth breathing to stimulate the heart and promote regular breathing.
Medical professionals may also use the:
- A Defibrillator – a device that helps restart the heart through an electrical shock
- Intubation – an invasive technique that involves forcing tubes into the body to deliver oxygen through the airways
Although it might seem like allowing resuscitation is always the best choice, many people with debilitating conditions or illnesses lead them to create a DNR form.
What Types of Resuscitation Will a DNR Form Prevent?
A DNR Order will stop the primary forms of resuscitation that are used to revive the heart:
- Cardiopulmonary resuscitation (CPR)
- Advanced cardiac life support (ACLS)
- Intubation
As long as you have a DNR form, health professionals aren’t legally allowed to attempt these life-saving techniques.
When Is a DNR Order Appropriate?
This is a question asked by many patients.
There is no correct answer. Instead, the answer is highly personal and can only be decided by each patient on a case-by-case basis.
Religious or philosophical beliefs
Many faiths and schools of philosophy hold that human life is sacred and is to be preserved for as long as possible. In preparing your DNR, you should consider your beliefs and your family’s.
In addition, some medical institutions are run by religious organizations and may be reluctant to implement a DNR, which contradicts the faith of the parent group.
Any medical directive should begin with a profound analysis of your thoughts and beliefs on the subject of life and its end, and you may wish to seek counseling from your faith leaders if you have questions.
Failing health or no medical benefit
DNR orders and other medical directives are often created in anticipation of serious illness. Medical professionals can treat many conditions and prolong life without curing the underlying problem.
If a treatment offers no medical benefit and simply allows the patient to continue in ever-declining health, do you wish to receive it?
Diminished quality of life
Many treatments carry such heavy side effects as reducing the quality of life. This is especially true with surgical procedures which remove some or all of an organ or cancer treatments.
If you will be left with a reduced capacity to function, do you wish to have resuscitation if you become unresponsive?
What Types of Treatment Can DNRs Cover?
A carefully crafted DNR order, made in consultation with your doctor, can cover a variety of situations that may arise during medical treatment.
A thorough discussion with your doctor is an essential first step to making any DNR.
Mouth-to-Mouth Breathing and Chest Compressions
Mouth-to-mouth resuscitation and chest compression form the basis for cardiopulmonary resuscitation, or CPR, the most common and most successful life-saving medical intervention available.
Medical experts routinely state that timely CPR by paramedics or in hospitals has saved many lives.
On the other hand, CPR does not always work, and in the event of its failure, a hospital may be inclined to try more drastic measures such as defibrillation or intubation. Also, aggressive chest compression can lead to cracked or broken ribs or other painful injuries, even if successful. A frail and elderly patient may be left worse than before.
Patients with terminal cancer or other end-of-life diseases often stipulate that no CPR be done in advance medical directives or living wills.
In preparing your DNR or other advance medical directives, you should consult carefully with your doctor about whether you wish to have mouth-to-mouth resuscitation, chest compression, or other forms of CPR performed.
Defibrillation and Intubation
Defibrillation, intubation, and other more extreme forms of life-saving medical intervention are often covered in DNR orders. Defibrillators are designed to shock a stopped heart back into beating after a cardiac event.
A defibrillator can often save lives if used promptly after cardiac arrest. A delay in heart restarting can lead to brain damage and other injuries, as the body depends on blood circulation to deliver oxygen.
A patient can thus have a “successful” outcome and still be left worse than before.
Intubation using a ventilator can keep lung function going, and deliver oxygen to a patient. The process of inserting a tube through the nose or mouth and into the lungs is so uncomfortable for the patient that it must always be done under complete sedation.
Because the tube effectively prevents food from being taken by mouth, the patient must also have nourishment intravenously. Intubation has a very low success rate, and intubated patients rarely recover.
Some hospitals and medical institutions treat a “Do Not Intubate” order as a separate medical directive distinct from a “Do Not Resuscitate” order.
You should confer with your healthcare providers to see if they treat these two orders as distinct medical directives, or combine them.
How to Create a DNR Order
Step 1 – Make an Informed Decision
Your doctor must help you understand your medical condition to make a medically informed decision. What are its treatment options? How successful are those options, and what are the likely side effects of each treatment choice?
Will your condition leave you with impaired function or a reduced quality of life? What is the long-term prognosis? Are any promising developments in the field likely to lead to near-term breakthroughs or promising clinical trials?
You should also talk to your doctor about the different resuscitation options available for patients with your condition. Talk about the benefits and risks of CPR, defibrillation, or intubation and the success rate of each.
Ask not only how these treatments affect patients but how they affect patients with your specific condition.
Once you have been fully informed of your medical situation, you can tell your doctor and healthcare professionals exactly what your treatment plan should be in the event you are incapacitated.
You should have a complete discussion of possible outcomes with your doctor, and together, you can begin to prepare any advance directives or orders you wish.
Step 2 – Prepare the DNR Order Form
Your doctor must write the DNR into your medical records at any institution you receive care. A doctor must sign it.
It must also include your name and the date it was placed on file.
Step 3 – Put your DNR Order in Place
Review your DNR order, any other advance care directive or living will, and your medical power of attorney to ensure that these documents reflect your wishes.
You should also advise your healthcare proxy or agent and any other individual you have empowered to make decisions (like the holder of a power of attorney) about your plans and wishes.
Finally, you should inform your family of your decision.
How to Get a DNR Form
Before the internet, getting a DNR form required an appointment with an attorney to draw up expensive paperwork and sign documents.
Today, getting a DNR document using an online DNR form builder is easier than ever.
Simply enter your information into the builder, print the customized paperwork, and sign it with your doctor. You can state your desires for end-of-life care in less than five minutes.
Take the time now to ensure you have control over one of the most important personal decisions you can make.
Related read: 9 End-of-Life Documents Everyone Needs
DNR Order FAQs
Does every U.S. state allow DNR orders?
Every state now allows DNR orders. However, there remains a wide variety of state laws on the subject. States may also use different terms to describe the DNR order.
Are DNR orders allowed only for people with certain health conditions?
No, anyone of legal age and sound mind can create a DNR order with their doctor and an advance healthcare directive or living will either on their own or with the help of an attorney. Indeed, it is usually better to have some plan in place beforehand in case of an accident or unforeseen emergency.
Can a family refuse a DNR order?
Only the person requesting the DNR order (usually the patient), the treating doctor, or the patient’s authorized representative with a healthcare power of attorney or living will revoke a DNR order. This is often a point of disagreement for family members, so it is always a good idea to make your wishes known well in advance.
Can you change your mind about your DNR?
Yes. Patients can always change their minds about DNR orders at any time. If you change your mind, simply advise your doctor of that fact. The doctor is required by law to cancel the medical order and remove it from the record. If you change your mind about a living will, medical power of attorney, or advance healthcare directive, you should advise the person you have designated as your representative in those documents that their power has been canceled. The best practice is to retrieve the document and physically destroy it. Some states require the cancellation of a living will or power of attorney in writing, which is also a good idea.
Family disagreement is typical with DNRs, living wills, and advanced healthcare directives. The family is often emotionally wrapped up in the situation and unwilling to accept that a loved one may die. At other times, a family member may suspect that a misdiagnosis has been made or that malpractice has occurred. Such beliefs may even be well-founded. Nevertheless, the medical staff will generally carry out the patient’s wishes or those of the patient’s representative under a healthcare power of attorney, living will, or advance directive. Disagreements are always unpleasant and challenging for the family and the medical staff. Many problems can be avoided by openly and honestly discussing your wishes with your family members beforehand.
