The do-not-resuscitate (DNR) order placed in a patient's medical record by a physician informs the medical staff that CPR (see Cardiac Arrest: Cardiopulmonary Resuscitation (CPR)) should not be done. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life.

Physicians discuss with patients the possibility of cardiopulmonary arrest, describe CPR procedures, and ask patients about treatment preferences. If the patient is incapable of making a decision about CPR, a surrogate may make the decision based on the patient's previously expressed preferences or, if such preferences are unknown, in accordance with the patient's best interests.

Almost all states have specialized DNR protocols for patients who are living at home or in any nonhospital setting. These protocols typically require the signing of an out-of-hospital DNR order by both the physician and patient (or the patient's surrogate) and the use of a special identifier (eg, a bracelet or brightly colored form) that is worn by or kept near the patient. If emergency medical personnel are called in case of emergency and see an intact identifier, they will provide comfort care only and not attempt resuscitation. These protocols are important to know because normally, emergency medical technicians are not expected to read or rely upon a living will or durable power of attorney for health care.

A DNR order does not mean "do not treat." Rather, it means only that CPR will not be done. Other treatments (eg, antibiotic therapy, transfusions, dialysis, use of a ventilator) that may prolong life can still be provided. CPR itself usually does not result in long-term, neurologically intact survival, but other treatments, including aggressive or critical care that prevents cardiac arrest, can. Thus, whether to pursue other treatments is a more important decision than whether to resuscitate. A person with a DNR order can still be treated aggressively in an intensive care unit if their condition warrants.

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