Getting a DNR (do-not-resuscitate) order starts with a conversation with your doctor. A DNR is a medical order, not a form you can fill out on your own. Your healthcare provider writes it after discussing your wishes with you, your healthcare proxy, or your family. Once signed, it instructs medical staff not to perform CPR if your heart stops or you stop breathing.
What a DNR Actually Covers
A DNR is narrow in scope. It only applies to resuscitation, meaning chest compressions, defibrillation, breathing tubes, and related emergency interventions used when someone’s heart or breathing stops. It does not affect any other medical treatment. You will still receive pain management, antibiotics, fluids, surgery, or any other care you consent to. A DNR simply means that if you go into cardiac or respiratory arrest, the medical team will not attempt to restart your heart or breathing.
Steps to Get a DNR Order
The process is straightforward but requires a medical professional’s involvement:
- Talk to your doctor. Tell your primary care provider or specialist that you want to discuss end-of-life preferences, specifically that you do not want CPR. Be direct. Doctors have these conversations regularly.
- Your doctor writes the order. If you’re in a hospital, the provider enters the DNR into your medical record. If you’re at home or in a care facility, your doctor fills out a state-specific form.
- Sign the required paperwork. Most states require both the physician’s signature and your signature (or your healthcare proxy’s). Some states allow physician assistants or nurse practitioners to sign as well.
- Get the right form for your setting. A hospital DNR only applies within that hospital. If you want your wishes honored at home or in an ambulance, you need an out-of-hospital DNR or a POLST form, which are separate documents.
Hospital DNR vs. Out-of-Hospital DNR
This distinction trips up a lot of people. A DNR written in your hospital chart applies only while you’re in that hospital. Once you’re discharged, emergency responders who arrive at your home have no access to that record and no obligation to follow it.
For your wishes to be honored outside a hospital, you need an out-of-hospital DNR order. This is a specific state-issued form that EMS personnel are trained to recognize. In many states, the out-of-hospital DNR requires a medical precondition: you typically must have a terminal diagnosis or be permanently unconscious for a physician to issue one. The form must be physically present and visible when paramedics arrive, whether posted on your refrigerator, kept in a bedside folder, or carried with you.
If 911 is called and no valid out-of-hospital DNR or POLST form is present, paramedics are legally required to perform CPR and transport you to a hospital. They cannot honor a verbal request from a family member in most jurisdictions. Only about 27% of EMS protocols across the country accept verbal DNRs from non-healthcare providers.
POLST: A Broader Alternative
A POLST (Physician Orders for Life-Sustaining Treatment) goes further than a standard DNR. While a DNR only addresses resuscitation, a POLST covers a range of decisions: whether you want full medical treatment, limited interventions, or comfort measures only. It also addresses choices about feeding tubes, antibiotics, and hospitalization.
POLST forms are designed for people who are seriously ill or frail, typically those whose doctor would not be surprised if they died within a year. The form is brightly colored (usually pink or green, depending on the state) so paramedics can spot it quickly. In some states, the POLST goes by other names like MOLST, POST, or MOST, but they function similarly.
Both POLST and out-of-hospital DNR forms are portable medical orders, meaning EMS personnel can act on them immediately without contacting a hospital for permission. About 76% of EMS protocols across the U.S. honor portable medical orders like the POLST, making them the most widely recognized format in emergency settings.
Why an Advance Directive Alone Isn’t Enough
Many people assume that a living will or advance directive covers them. It does not in an emergency. An advance directive is a legal document that outlines your healthcare preferences, but it is not valid outside of a medical facility. If paramedics respond to a 911 call at your home, they will not honor a living will or advance directive. They are legally required to begin resuscitation and transport you to a hospital.
Only a DNR order or POLST form carries weight with EMS. That said, an advance directive is still valuable. It guides your healthcare proxy and hospital staff in making broader treatment decisions if you become unable to communicate. The most complete approach is to have both: an advance directive for hospital-based decisions and a POLST or out-of-hospital DNR for emergencies at home.
DNR Identification for Emergencies
Some states allow DNR bracelets or necklaces as valid identification. About 61% of EMS protocols recognize DNR jewelry as an acceptable form of verification. This can be critical if you collapse in public or at home and the physical form isn’t immediately visible. Check your state’s requirements, because not all states accept jewelry, and the specific design or engraving required varies.
Traveling Across State Lines
DNR orders are not automatically honored in other states. Each state has its own form, its own rules, and its own requirements for what EMS personnel will accept. Florida, for example, recognizes advance directives from other states in general healthcare settings, but its paramedics will only honor Florida’s own DNR form. Illinois and Wisconsin are similarly restrictive in practice, even if their laws don’t explicitly address the issue.
If you spend time in more than one state, consider obtaining a valid DNR or POLST form in each state where you live or travel frequently. Your doctor in one state can coordinate with a provider in another to ensure the paperwork is completed correctly.
Changing Your Mind
A DNR is not permanent. You can revoke it at any time, for any reason, with no waiting period. You can cancel it verbally, in writing, or simply by removing or destroying your DNR identification. Even after a DNR protocol has been activated, you can revoke it by requesting resuscitation. Your attending physician can also discontinue the order on your behalf. No one can prevent you from reversing this decision.