A DNR, or do-not-resuscitate order, is a medical order that tells healthcare providers not to perform CPR if your heart stops beating or you stop breathing. It is written by a doctor (or in some states, a nurse practitioner or physician assistant) and placed in your medical record. A DNR does not affect any other medical treatment you receive. It only applies at the moment of cardiac or respiratory arrest.
What a DNR Actually Covers
CPR involves more than chest compressions. When someone’s heart stops, the full resuscitation effort can include mouth-to-mouth breathing, chest compressions, electric shocks to restart the heart (defibrillation), breathing tubes inserted into the airway, medications, and external cardiac pacing. A DNR order tells medical staff to withhold all of these interventions.
Everything else about your medical care stays the same. You still receive medications, pain management, antibiotics, fluids, surgery, and any other treatment your condition requires. A DNR only activates if your heart or breathing stops entirely. Until that point, your care team treats you like any other patient.
Why People Choose a DNR
CPR survival rates are lower than most people expect. Across large studies, only about 15 to 17 percent of people who receive CPR in a hospital survive to leave the hospital. The success rate outside a hospital is similar or lower. For people with serious underlying illnesses, advanced cancer, or multiple organ failure, the odds drop further. Even when CPR restores a heartbeat, the period without oxygen can cause lasting brain damage.
For someone with a terminal illness or advanced age, the realistic outcome of CPR may be a brief extension of life in an intensive care unit rather than a meaningful recovery. A DNR allows that person to die naturally instead of undergoing an aggressive, often physically traumatic intervention with a low chance of a good outcome. It’s a personal decision that reflects individual values about quality of life, dignity, and what constitutes acceptable medical intervention.
DNR vs. DNI
A DNR and a DNI (do-not-intubate) order are separate decisions, though they’re often confused. A DNR covers cardiac arrest, when the heart has stopped. A DNI covers respiratory failure, when you can’t breathe adequately but your heart is still beating. These are clinically distinct situations with very different survival odds.
In-hospital cardiac arrest carries a mortality rate above 75 percent. Respiratory failure requiring a breathing machine, on the other hand, has mortality rates below 40 percent in the general population. The breathing machine is used far more often for treatable conditions like pneumonia, heart failure, or complications after surgery than for cardiac arrest. In practice, some physicians incorrectly treat a DNR as though it also means DNI, withholding the breathing machine even when the patient’s heart is still beating. If you want one order but not the other, make that distinction explicit with your doctor.
How to Put a DNR in Place
You don’t need a lawyer or an advance directive to get a DNR. You tell your doctor, your doctor writes the order, and it goes into your medical chart. In a hospital or nursing facility, that chart note is enough for staff to follow.
Outside of a hospital, the process requires an additional step. Every state has some form of out-of-hospital DNR, sometimes called a Comfort Care order or No CPR order. These portable orders typically require signatures from both the doctor and the patient (or the patient’s surrogate). They come with a visually distinct form, bracelet, or necklace that paramedics and emergency responders can quickly identify. In Texas, for example, a specially inscribed bracelet or necklace can serve in place of the paper form. The American Hospital Association has recommended that hospitals use purple wristbands specifically to indicate DNR status.
If you have a DNR but no visible identification when paramedics arrive, they will default to performing CPR. Emergency responders are trained to resuscitate unless they see clear, valid documentation saying otherwise.
Who Can Request a DNR for Someone Else
If a person can’t make medical decisions for themselves, an authorized surrogate can request a DNR on their behalf. This is typically a healthcare power of attorney (also called a healthcare proxy, agent, or surrogate), someone the patient named in a legal document while they were still capable of making decisions. If no one was formally designated, state law determines who has authority, usually a spouse, adult child, or parent.
The surrogate is expected to make decisions that align with what the patient would have wanted, based on the patient’s known values and any prior conversations. A healthcare provider can refuse to follow a surrogate’s request if it conflicts with accepted medical standards, the provider’s conscience, or institutional policy. In that case, the provider must notify the surrogate and consider transferring the patient’s care.
How a DNR Fits With Other Advance Directives
A DNR is a medical order, not a legal document. It sits in your chart and directs clinical staff in real time. A living will is a legal document where you describe your broader wishes for end-of-life care, such as whether you want artificial nutrition, dialysis, or comfort measures only. A living will might state that you don’t want CPR, but having a separate DNR order in your medical record makes that wish immediately actionable for hospital staff.
A POLST (Physician Orders for Life-Sustaining Treatment, sometimes called MOLST) goes further than a DNR. Available in all 50 states under various names, a POLST translates your medical wishes into a set of physician orders that follow you between settings: hospital, nursing home, ambulance, or your own home. It covers CPR but also addresses other interventions like antibiotics, feeding tubes, and levels of treatment intensity. The 2025 American Heart Association guidelines identify POLST as the best method for documenting advance care plans related to CPR, because it functions as a medical order rather than just a statement of preference.
A POLST is designed for people with serious illness. It supplements, rather than replaces, a living will or healthcare power of attorney.
Changing or Revoking a DNR
A DNR is not permanent. You can revoke it at any time by telling your doctor, and the order will be removed from your chart. If you have an out-of-hospital DNR bracelet or form, destroying it effectively revokes the order for emergency responders. Your medical wishes can evolve as your health situation changes, and no one is locked into a decision made at an earlier point in their care.