Do Not Resuscitate Order (DNR)

A do-not-resuscitate order (DNR) is a physician-signed medical order instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing. It is a legally recognized directive that reflects a patient's informed decision to forgo resuscitation efforts. A DNR does not restrict other medical care: Pain management, medication, and other treatments continue unless separately addressed.

How a DNR order works

A patient or their authorized healthcare representative initiates the request, typically in consultation with a physician. The physician then documents and signs the order—without that signature, the document is not a valid medical order. Once signed, the order is placed in the patient's medical record and accessible to all treating staff.

For out-of-hospital settings, most states require a separate form, sometimes called a Physician Orders for Life-Sustaining Treatment (POLST), that emergency medical personnel can honor. A DNR does not require attorney involvement, but it must comply with the requirements of the state where it is issued.

Why a DNR order matters

Without a DNR, healthcare providers are generally obligated to attempt resuscitation in an emergency, regardless of a patient's underlying condition or previously expressed wishes. For individuals with terminal illness or serious chronic conditions, resuscitation may cause significant physical trauma with little chance of meaningful recovery. A DNR ensures that medical teams act in accordance with the patient's values and relieves family members of the burden of making that decision in a crisis.

Key characteristics

• Physician-issued: A DNR is a medical order, not a personal statement. It must be authorized by a licensed physician to be enforceable.
• Scope-limited: It applies only to CPR and resuscitation, not to other forms of treatment.
• Revocable: A patient with decision-making capacity can cancel a DNR at any time, verbally or in writing, without a formal legal process.
• State-specific: Form requirements, witness rules, and out-of-hospital validity differ by state. A DNR valid in one state may not be automatically honored in another.
• Not the same as a living will: A DNR is a physician's order; a living will is a patient's written statement of preferences. Both can address resuscitation but serve different legal and medical functions.

DNR order vs. advance directive

An advance directive, such as a living will or healthcare power of attorney, is a legal document created by the individual to express medical preferences. It is not a physician's order and cannot, on its own, instruct medical staff to withhold CPR.

A DNR is an active medical order that healthcare providers must follow. In practice, a patient may use an advance directive to communicate their wish for a DNR, which a physician then translates into an actual order. The two documents work together but are not interchangeable.

Related terms

• Advance directive: A legal document in which an individual states medical care preferences and may appoint a healthcare agent. A DNR is often established alongside an advance directive.
• End-of-life care: Medical and supportive care provided during the final stages of a serious illness. DNR orders are a common element of end-of-life care planning.

FAQs about a DNR

Does a DNR mean a patient won't receive any treatment?

No. A DNR applies only to CPR and directly related resuscitation interventions. A patient can still receive antibiotics, pain medication, surgery, or any other treatment that aligns with their goals.

Can a patient cancel a DNR after signing one?

Yes. A patient with decision-making capacity can revoke a DNR at any time, verbally, in writing, or by destroying the document. The medical team should be notified immediately so the order can be removed from the record.

Who can request a DNR for a patient who can no longer make decisions?

In most states, a healthcare proxy designated through a healthcare power of attorney has this authority. Without a designated proxy, it typically passes to next of kin in a legally prescribed order, which may not reflect the patient's actual wishes.

Is a DNR valid in every state?

Not automatically. Requirements for form, witnesses, and out-of-hospital validity differ by jurisdiction. Patients who divide time between states should confirm their DNR complies with the laws of each relevant state.