What is a DNR order?

95. What is a DNR order?

DNR stands for “do not resuscitate” and is a common
component of advance directives, including a living
will. A DNR order dictates the steps to be taken if a
patient is found to be minimally responsive with minimal
life signs. It mandates whether medical steps, such
as intubation or cardiopulmonary resuscitation (CPR),
should be administered if a patient goes into cardiac
arrest. The Patient Self-Determination Act enacted in
1991 gives all patients the right to accept or refuse
resuscitative efforts in accordance with state laws or
statutes.


Do not resuscitate order (DNR) = Can be a component
of an advance directive and a living will; specifies the 
medical steps to be taken in the event the patient is found 
to be minimally responsive with minimal life signs.


The DNR order is a difficult issue for patients, families,
and healthcare providers. It is a potentially emotional
topic and decision, and may generate conflicts
between/among the people involved if there is disagreement
about the right course of action. For example,
some patients and family members may believe
that, under all circumstances, all efforts should be
made to prolong life and would therefore refuse a
DNR order. Other people may believe that death
should occur more naturally, without life support and
other medical interventions, and agree to a DNR
order. Caregivers and family members may certainly
express their beliefs; however, individual feelings and
conflict should be tempered by an understanding of
the patient’s true wishes.

To protect themselves with advance directives, patients
should be encouraged to initiate a discussion of their
wishes with their healthcare team and their family, and
particularly with their physician(s) and their healthcare
proxy—not only so that their wishes are upheld, but also
so that the doctor and the proxy understand their wishes.

Having these difficult, but meaningful conversations in
advance removes a lot of the burden of making these
decisions from the family and friends. They will not have
to guess or speculate about the patient’s wishes.

Additionally, it is important to understand that a
DNR order does not mean the withdrawal of care.

Patients will not be segregated into a separate section
of the hospital and neglected while “waiting to
die.” Their medical needs such as pain control or
other supportive medical care will be provided. The
DNR order comes into play only if a patient requires
resuscitation.

Nancy’s comment:

A copy of the DNR, healthcare proxy, and/or living will
statements should be kept in a visible and accessible place in
the patient’s home. Should the caregiver or someone else
find the patient dying or dead in the house, you should
know that a 911 call will bring EMT personnel whose
task is to revive the patient and provide life support while
transporting him or her to the emergency room—exactly
the opposite of what the DNR and most living wills are
intended to convey. Even if the patient is taken to a hospital
that has treated him or her before—which isn’t guaranteed
in an emergency—ER personnel don’t necessarily have
access to the patient’s chart in the doctor’s office or hospital
records and probably will not check for a DNR order. If the
caregiver doesn’t have a healthcare proxy document in hand
and can’t immediately produce the living will or DNR
documents, he or she will be unable to insist that the hospital
personnel do not attempt resuscitation. So it’s very
important to make sure that these records are kept in a
prominent place if the patient doesn’t want resuscitation or
heroic measures.