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Do-not-resuscitate order

No code; End-of-life; Do not resuscitate; Do not resuscitate order; DNR; DNR order; Advance care directive - DNR; Health care agent - DNR; Health care proxy - DNR; End-of-life - DNR; Living will - DNR

A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.

What is a DNR?

Ideally, a DNR order is created, or set up, before an emergency occurs. A DNR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition.

The doctor writes the order only after talking about it with the patient (if possible), the proxy, or the patient's family.

What is Resuscitation?

CPR is the treatment you receive when your blood flow or breathing stops. It may involve:

Making the Decision

If you are near the end of your life or you have an illness that will not improve, you can choose whether you want CPR to be done.

These can be hard choices for you and those who are close to you. There is no hard and fast rule about what you may choose.

Think about the issue while you are still able to decide for yourself.

A DNR order may be a part of a hospice care plan. The focus of this care is not to prolong life, but to treat symptoms of pain or shortness of breath, and to maintain comfort.

If you have a DNR order, you always have the right to change your mind and request CPR.

How is a DNR Order Created?

If you decide you want a DNR order, tell your doctor and health care team what you want. Your doctor must follow your wishes, or:

The doctor can fill out the form for the DNR order.

Make sure to:

If you do change your mind, talk with your doctor or health care team right away. Also tell your family and caregivers about your decision. Destroy any documents you have that include the DNR order.

When You are Unable to Make the Decision

Due to illness or injury, you may not be able to state your wishes about CPR. In this case:

If you have not named someone to speak for you, under some circumstances, a family member can agree to a DNR order for you, but only when you are not able to make your own medical decisions.

References

Arnold RM. Palliative care. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 3.

Bullard MK. Medical ethics. In: Harken AH, Moore EE, eds. Abernathy's Surgical Secrets. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 106.

Moreno JD, DeKosky ST. Ethical considerations in the care of patients with neurosurgical disease. In: Cottrell JE, Patel P, eds. Cottrell and Patel's Neuroanesthesia. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 26.

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Review Date: 1/12/2020  

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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