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A do-not-resuscitate (DNR) order placed in a person's medical record by a doctor informs the medical staff that cardiopulmonary resuscitation (CPR—see First Aid: First-Aid Treatment) should not be performed. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life.

Doctors discuss with patients the possibility of cardiopulmonary arrest (when the heart stops and breathing ceases), describe CPR procedures, and ask patients about treatment preferences. If a person is incapable of making a decision about CPR, a surrogate may make the decision based on the person's previously expressed preferences or, if such preferences are unknown, in accordance with the person's best interests.

A DNR order does not mean "do not treat." Rather, it means only that CPR will not be performed. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. Treatment that keeps the person free of pain and comfortable (called palliative care) should always be given.

Most states also provide for special DNR orders that are effective outside of hospitals, wherever the person may be in the community. These are called out-of-hospital DNR orders, Comfort Care orders, No CPR orders, or other terms. Generally, they require the signature of the doctor and patient (or patient's surrogate), and they provide the patient with a visually distinct quick identification form or bracelet or necklace that emergency medical services personnel can identify and comply with. These orders are especially important for terminally ill people living in the community who want only comfort care and no resuscitation if their heart or breathing stops. Living wills and durable powers of attorney for health care are not generally effective in emergency situations.

Medical Terms Related to Life-Sustaining Treatment Cardiopulmonary resuscitation (CPR): An action taken to revive a person whose heart stops (cardiac arrest), whose breathing stops (respiratory arrest), or whose heart and breathing stop (cardiopulmonary arrest). Code: The summoning of professionals trained in CPR to revive a person in cardiac, respiratory, or cardiopulmonary arrest. No code: An order signed by a person's doctor stating that CPR should not be performed. (Also called a do-not-resuscitate [DNR] order.) Irreversible coma: A coma or persistent vegetative state from which the person will not recover. Terminally ill: The medical state of being near death where there is no hope of cure. Life-sustaining treatment: Any treatment given to postpone the death of a terminally ill person. Palliative care: Measures taken to keep a terminally ill person as comfortable as possible.

Last full review/revision October 2007 by Charles Sabatino, JD