Understanding a DNR

Advance directives give important directions for medical care, but to be official, a person’s wishes need to be put into medical orders.  An important medical order that many people want when they are very old and/or terminally ill is a Do Not Resuscitate order.

A Do Not Resuscitate order tells medical professionals not to take action even if someone’s heart and breathing stops.  This means that doctors, nurses and emergency medical personnel will not use emergency CPR to try to revive someone.

DNR orders are designed to help people who are in the final stages of a terminal illness, who suffer from a chronic serious condition, or who are old and ready to die. 

Often, the process of establishing a DNR order helps people begin to come to terms with death—whether it is their own or the death of a loved one.

Consider these examples:

• Mr. Smith is in the hospital suffering from severe kidney disease.  After discussions with his doctor and his family, Mr. Smith has asked his doctor to sign a DNR order.  He knows that if his heart and breathing stop, no one will attempt CPR or use a ventilator to keep him alive.  In addition, he has asked that he not be put on kidney dialysis.  Mr. Smith is ready to die.
• Mrs. Turner lives in a skilled nursing home.  She has severe Alzheimer’s disease.  Eight years ago, Mrs. Turner created a living will.  Her living will states that she does not want CPR performed on her.  To honor these wishes, and after speaking with the family, her doctor has written a DNR order.  This means that if Mrs. Turner stops breathing, the staff of the nursing home will not attempt CPR and will not call 911 to transfer Mrs. Turner to a hospital.  If Mrs. Turner had not had a living will, her HCPOA or family could have made the decision for her to be a “DNR” because they believe this to be what she wanted.
• Mr. Jones is 90 years old and in fairly good health for his age. He says he has had a good life and if his heart or lungs should stop working, he wants people to wish him well with thankfulness and allow death to come undisturbed.  

DNR orders must be signed and dated by a physician.  They may be written for people in hospitals, nursing homes, assisted living facilities—and, in most states, for people living in their own homes.

Generally, paramedics working in the community have a duty to perform CPR when a person’s heart or breathing stops.  For people still living at home,  many states have a special DNR order—called a “Prehospital DNR”, an “Out-of Hospital DNR” or a “Portable DNR”.  If you are a home health aide, you may see one of these forms.  It is usually written on brightly colored paper and should be posted in an obvious place so that the paramedics know not to resuscitate the person.

Some states have portable DNR bracelets that alert paramedics that a DNR order has been written by the person’s physician.

NOTE:  A person’s advance directive might include instructions about not wanting CPR or other forms of resuscitation.  However, to be official, that wish must be written as a physician’s order.  This gives the entire health care team specific instructions which they must follow.