Do-Not-Resuscitate Orders

Definition

Do not resuscitate (DNR) order is a part of advanced medical directives allowed by federal law passed in 1991, expanding the notion of patient autonomy to situations in which they may not be able to make crucial medical decisions due to incapacitation. It instructs medical personnel not to perform life-saving cardiopulmonary resuscitation (CPR) or other procedures to restart the heart or breathing once they have ceased. By law, the DNR directive must be offered as an option to patients by health providers in, and in some states, out of a hospital setting. Once signed, the DNR directive must be placed in the in the patient's chart.

Purpose

With such advanced cardiopulmonary techniques as CPR, it is possible to keep almost any patient's heart and lungs functioning, independent of how terminal or hopeless their medical condition becomes. The DNR program is designed to help people in the final stages of a terminal illness or who have intractable pain the option for deciding against life-saving measures that may only prolong their pain and death. The option of deciding against life-saving measures is considered to be a formal part of patient autonomy and is respected as an ethical subset of medical informed consent.

Description

DNR orders affect a small group of patients and are designed to avoid the suffering of a terminal illness or other serious conditions that are medically irreversible. The order actually authorizes medical treatment to be withheld. It is included with the medical orders in the medical chart, and with it, hospital and pre-hospital personnel are restricted from using CPR techniques and other measures to revive the patient.

Some states allow DNR orders only in hospital settings. Other states allow DNR orders to be honored by emergency responders working outside the hospital setting. Over half of the states in the United States have pre-hospital DNR orders. A physician must sign the pre-hospital DNR directives. The state's Emergency Medical Service (EMS) department or state medical association administers the programs. In some states, the DNR may be called a pre-hospital medical care directive or a comfort care only document.

A DNR order can be revoked at any time in any way that effectively communicates the patient's desire. It can come from the patient in the form of a letter or document. It can come from the patient telling an emergency provider to disregard the order. The revocation can be invoked by removing any bracelet or medallion that indicates DNR status. It can be communicated by the designated health agent or patient representative who has the power to express the patient's wishes to health providers. Some states maintain a registry for individuals with DNR orders. It is important to find out about a state's service for DNR and its particular legal forms and requirements. Many patients who die in a hospital have had a DNR order.

Content licensed from:

Author Info: Nancy McKenzie Ph.D., The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Surgery, 2004

This feature is for informational purposes only and should not be used to replace the care and information received from your healthcare provider. Please consult a healthcare professional with any health concerns you may have.