What Is a DNR (Do Not Resuscitate) Order?
By CRYSTAL BAI •
The short answer: A DNR (Do Not Resuscitate) order is a medical order that instructs healthcare providers not to perform CPR (cardiopulmonary resuscitation) if a patient's heart stops or they stop breathing. It must be signed by a physician and is placed in the medical record. A DNR reflects a patient's choice to die naturally rather than undergo potentially traumatic resuscitation efforts.
What Is a DNR Order?
A Do Not Resuscitate (DNR) order — also called a DNAR (Do Not Attempt Resuscitation) or AND (Allow Natural Death) order — is a physician-signed medical order that instructs hospital staff, emergency responders, and other healthcare providers not to perform CPR if a patient's heart stops beating (cardiac arrest) or they stop breathing (respiratory arrest).
A DNR is not a living will or an advance directive — it is an active medical order, like a prescription, that is placed in a patient's medical record and (in out-of-hospital settings) kept physically accessible for EMS. It requires a physician or in some states a nurse practitioner to sign it.
What Does CPR Actually Involve?
Understanding what a DNR declines helps put the decision in context. CPR in a hospital setting typically includes:
- Chest compressions — forceful compression of the chest at 100–120 times per minute to maintain blood flow. This frequently breaks ribs, especially in elderly or frail patients.
- Defibrillation — electric shocks to the heart
- Intubation and mechanical ventilation — a tube placed through the mouth into the lungs, connected to a breathing machine
- Medications — epinephrine and other drugs administered intravenously
For patients with serious terminal illness, the survival rate for in-hospital CPR is generally 10–20%, and survivors often have reduced quality of life. For patients with advanced cancer, end-stage organ failure, or other serious illness, the chance of meaningful recovery after CPR is far lower — sometimes less than 5%. A DNR acknowledges this reality and chooses dignity over the small possibility of survival.
DNR in Hospital vs. Out of Hospital
In-Hospital DNR: Entered into the medical record. When a patient arrests, the code team is not called. The patient is kept comfortable.
Out-of-Hospital DNR (OHDNR) / POLST: A separate document that travels with the patient — kept at home (often on the refrigerator, as recommended by EMS), in a nursing facility, or with the patient. When EMS arrives, they check for this document. Without it, EMS is typically legally required to attempt resuscitation. Most states have a specific Out-of-Hospital DNR form (sometimes orange or bright-colored for visibility) that is distinct from the in-hospital DNR order.
DNR vs. POLST vs. Advance Directive
| Document | What it is | Who signs | Where it applies |
|---|---|---|---|
| DNR | Order not to perform CPR | Physician/NP | Hospital or out-of-hospital |
| POLST/MOLST | Broader medical orders (includes DNR, ventilator, hospitalization preferences) | Physician/NP + patient | All settings, travels with patient |
| Advance Directive (Living Will) | Patient's stated preferences for future situations | Patient + witnesses | Guides decisions when patient lacks capacity; not immediately actionable like a medical order |
Who Should Consider a DNR?
DNR orders are appropriate for patients who:
- Have a terminal diagnosis where CPR is unlikely to restore meaningful function
- Are enrolled in hospice (most hospice patients choose DNR status)
- Have advanced age or frailty where CPR would cause significant harm with little benefit
- Have had explicit conversations with their physician about the realistic outcomes of CPR given their specific condition
Choosing a DNR is not "giving up." It is choosing a specific kind of death — one that is peaceful and natural — over a traumatic intervention that is unlikely to restore quality life. Many physicians who specialize in end-of-life care have their own DNR orders on file.
Does a DNR Affect Other Care?
A DNR applies only to CPR. It does not mean:
- No other treatment (IV fluids, antibiotics, pain management, anti-nausea medications all continue)
- No emergency care (a patient can still be taken to the ER for a broken bone, bleeding, or other acute problems)
- No comfort measures (hospice and palliative care continue in full)
A DNR is a single, specific decision about one intervention — resuscitation — not a blanket withdrawal of care.
How to Get a DNR
Talk to your physician or hospice provider. The conversation typically involves reviewing your prognosis, discussing what CPR involves and its likely outcomes given your specific condition, and confirming that a DNR aligns with your values and goals. The physician then writes the order. A death doula can help prepare you for this conversation and help you articulate what matters most to you.
Frequently Asked Questions
What is a DNR order?
A Do Not Resuscitate (DNR) order is a physician-signed medical order instructing healthcare providers not to perform CPR if a patient's heart stops or they stop breathing. It is placed in the medical record and, for out-of-hospital settings, kept physically accessible for EMS.
Does a DNR mean no treatment?
No. A DNR applies only to CPR — it does not mean withdrawing other treatment. Patients with a DNR still receive pain management, medications, IV fluids, and other care. A DNR is a single, specific decision about resuscitation, not a blanket withdrawal of care.
What is the difference between a DNR and a POLST?
A DNR is a specific order about CPR. A POLST (or MOLST/MOST depending on state) is a broader set of medical orders covering CPR, ventilator use, artificial nutrition, and hospitalization preferences. Most POLST forms include a DNR section. Both are physician-signed medical orders that travel with the patient.
How do I get a DNR order?
Talk to your physician or hospice provider. The conversation involves reviewing your prognosis and what CPR realistically means for your specific condition. The physician then writes the order. A death doula can help you prepare for this conversation and articulate your values.
Is choosing a DNR giving up?
No. Choosing a DNR is choosing a specific kind of death — peaceful and natural — over an intervention that is unlikely to restore meaningful quality of life for many seriously ill patients. Many end-of-life physicians have their own DNR orders on file. It is an act of intentionality, not surrender.
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