Do Not Resuscitate Orders: 4 Practical Steps For Families

Do Not Resuscitate (DNR) orders serve as critical medical directives that guide healthcare providers on withholding cardiopulmonary resuscitation (CPR) when a patient’s heart or breathing ceases. These orders empower individuals facing serious illnesses to align end-of-life care with their personal values, avoiding aggressive interventions that may prolong suffering rather than restore quality of life.

Defining DNR and Related Directives

A

DNR order

is a physician-issued instruction placed in a patient’s medical record, directing staff not to perform CPR, including chest compressions, defibrillation, or intubation, if cardiac or respiratory arrest occurs. It applies specifically to resuscitation efforts and does not affect other treatments like pain management or antibiotics.

Variations exist, such as

Do Not Intubate (DNI)

orders, which allow CPR but prohibit breathing tubes to prevent ventilator dependency and related complications. Full-code status, conversely, mandates all resuscitative measures.

Directive Type	What It Allows	What It Prohibits
DNR	Pain relief, comfort care	CPR, defibrillation, intubation
DNI	CPR, chest compressions	Intubation, ventilators
Full Code	All resuscitative measures	None

These distinctions help patients tailor directives to their preferences, often discussed in advance to prevent crises.

The Process of Establishing a DNR Order

Physicians issue DNR orders after thorough discussions with patients, healthcare proxies, or families, ideally before emergencies arise. The order integrates into the medical chart for visibility to all providers.

For out-of-hospital scenarios, states provide specific forms. California’s Prehospital DNR form instructs EMS to forgo resuscitation upon verification, while Texas’s Out-of-Hospital DNR program similarly respects patient choices. Iowa emphasizes MedicAlert identifiers for quick recognition by paramedics.

• Consult your doctor about terminal illness or poor prognosis.
• Discuss goals: comfort over prolongation.
• Obtain and display the form visibly at home.
• Revise anytime by destroying the form and notifying providers.

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DNR in Hospital vs. Home Settings

In hospitals, DNRs activate automatically for eligible patients. Out-of-hospital, EMS requires clear documentation; without it, resuscitation proceeds to avoid errors.

Wearable alerts or wallet cards enhance compliance, ensuring first responders honor wishes swiftly.

DNR Orders and Hospice Care Integration

Hospice prioritizes comfort, not cure, making DNRs common but not mandatory. VITAS Healthcare admits patients without DNRs, respecting full-code preferences. Hospice teams discuss resuscitation to align care with wishes, focusing on symptom relief.

Patients choose DNRs for natural death assurances or full-code for hope of recovery, avoiding family burdens in crises.

Distinguishing DNR from Living Wills and POLST

DNRs target immediate resuscitation, while

living wills

outline broader artificial life support refusals for terminal conditions.

POLST (Physician Orders for Life-Sustaining Treatment)

expands to multiple interventions, portable across settings.

• DNR: Doctor-written, CPR-specific.
• Living Will: Patient-prepared, future scenarios.
• POLST: Comprehensive, EMS-recognized.

State Variations and Legal Considerations

DNR protocols differ by state. California mandates official forms for EMS; Iowa requires MedicAlert for home DNRs; Texas focuses on out-of-hospital programs. Always verify local rules via health departments.

Legally, DNRs bind providers once documented; loved ones cannot override valid orders.

Reasons Patients Opt for DNR Orders

Many select DNRs to avoid CPR’s low success in terminal cases—often causing rib fractures or futile prolongation—and prioritize dignity. Others fear “machines and tubes,” seeking peaceful passage.

Full-code choices stem from optimism or fear of premature decisions.

Revoking or Changing a DNR Order

DNRs remain revocable: verbally request CPR, destroy forms, or update records. Notify doctors and family promptly.

Practical Steps for Families

1. Initiate end-of-life talks early.
2. Document wishes in advance directives.
3. Share copies with providers and EMS registries.
4. Review periodically as health changes.

Frequently Asked Questions About DNR Orders

Does hospice require a DNR?

No, providers like VITAS accept full-code patients; it’s a personal choice discussed upon admission.

Can EMS ignore a DNR?

No, if properly documented and verified; otherwise, they resuscitate to err on caution.

Is a DNR the same as withdrawing all care?

No, it only affects CPR; comfort measures continue.

Who can request a DNR?

Competent patients or proxies after physician consultation.

Does a DNR speed up death?

No, it allows natural dying without resuscitation attempts.

Empowering Choices Through Education

Understanding DNRs fosters informed decisions, reducing crisis uncertainties. Combine with durable powers of attorney for comprehensive planning, ensuring voices endure.