A Do Not Resuscitate (DNR) order is a serious medical instruction regarding end-of-life emergency care. This order dictates the limits of intervention if a person’s heart or breathing ceases. Confusion often arises because patients and families may incorrectly assume it means all medical treatment will stop. Understanding what a DNR order includes and excludes is fundamental to honoring a patient’s wishes during a health crisis.
What a Do Not Resuscitate Order Means
A Do Not Resuscitate order is a legally recognized medical instruction directing healthcare providers not to attempt Cardiopulmonary Resuscitation (CPR) if a patient experiences cardiac or respiratory arrest. This definitively means that CPR will not be attempted. CPR is intended to revive a person whose heart has stopped or who has stopped breathing, but its success rate is very low, especially for patients with severe or terminal illnesses.
The order prohibits specific life-saving measures collectively known as resuscitation efforts. These actions include chest compressions, which manually circulate blood. Providers will also withhold artificial ventilation, which involves placing a breathing tube (intubation) and connecting the patient to a mechanical ventilator. Defibrillation, the use of an electrical shock to restart a heart, is also prohibited under a DNR.
Medical Treatments Still Provided Under DNR
A common misconception is that a DNR order means “do not treat,” which is inaccurate. The DNR order focuses only on what happens if the heart or breathing stops; it does not affect routine medical care. Patients with a DNR continue to receive treatment aimed at managing their current condition and ensuring comfort.
Patients with a DNR still receive necessary medical support, such as antibiotics, oxygen therapy, and pain management medications. Other interventions like wound care, diagnostic tests, and dialysis can also continue if they align with the patient’s care goals. The order prevents the use of heroic measures, allowing for a natural death while maintaining a focus on palliative and comfort care.
How a DNR Order is Established
Establishing a DNR order requires a formal process that translates a patient’s wishes into an actionable medical command. The order must be issued and signed by a physician or authorized healthcare provider after a consultation with the patient or their legal decision-maker. This ensures the patient fully understands the consequences of declining life-sustaining treatments.
The documentation differs based on the patient’s location. An In-Hospital DNR is noted in the patient’s medical record and is often called a “no code” order. For patients outside a facility, an Out-of-Hospital DNR requires a specific form that alerts emergency medical services (EMS) personnel not to attempt resuscitation. Some states require identifying markers, such as a colored form or a wearable item like a bracelet, to make the order immediately recognizable to first responders.
Distinguishing DNR from Other Directives
The DNR order is often confused with other advance care planning documents, but each serves a distinct purpose. A Living Will is a broader legal document expressing a patient’s general wishes regarding life-sustaining treatment if they become terminally ill or permanently unconscious. However, a Living Will alone is not sufficient to stop CPR in an emergency without a separate, specific DNR order written by a doctor.
Another specific medical order is Do Not Intubate (DNI), which prohibits the insertion of a breathing tube for mechanical ventilation, but does not prohibit chest compressions or defibrillation. A DNR, by contrast, prohibits both intubation and CPR efforts. Physician or Medical Orders for Life-Sustaining Treatment (POLST/MOLST) forms are standardized medical orders portable across care settings. These forms cover a wider range of treatments than a DNR, translating a patient’s wishes into medical orders covering CPR, intubation, feeding tubes, and antibiotics.