Do-Not-Resuscitate: What Is It and How Does It Work?

If you are a patient, family member, or caregiver of someone with an advanced or chronic illness or someone nearing the end of their life, then you have probably heard the phrase "Do Not Resuscitate" or "DNR." If you haven't heard this term before, don't worry: it’s not something most people need to think about regularly. In fact, if you've never had a heart attack or other medical emergency requiring CPR, chances are good that your only exposure to DNRs is through TV dramas and news reports. Still, because it can be so important for people who are seriously ill and may need CPR one day, here's what you need to know about DNRs.

What Is a DNR?

A do-not-resuscitate (DNR) order is a legally binding, written instruction from a physician that tells health care providers not to perform cardiopulmonary resuscitation (CPR) if your heart or breathing stops. The goal of CPR is to keep blood flowing through the body when someone's breathing or heart stops.

What a DNR Does and Doesn't Do

A DNR order is a powerful document. It means that you don't want CPR if your heart or breathing stops. It does not mean that you will not be treated in the event of a medical emergency. A DNR does not contain any instructions for additional treatments, like medication.

Who Needs a DNR?

A DNR order can be written for anyone for any reason with signed legal paperwork from a doctor or, in some states, a physician's assistant or nurse practitioner. Some states also require the signature of a notary public for a DNR to be legally sound. 

Common situations in which a person would consider a DNR:

• terminal illness

• chronic illness

• decreasing quality of life

• having a higher risk of a medical emergency that leaves them unable to make their own medical decisions

A DNR is also often considered if a person has a medical condition that causes them to have a lower chance of survival, even if CPR is performed. Though CPR can be successful in resuscitating someone, the negative impacts of the procedure outway the benefits. It is common for people to experience brain damage, heart damage, lung injury, broken bones, and internal bleeding after CPR is performed. The risk of these types of injuries happening increases if the patient is older or has an illness or disability. 

Many healthy people also consider a DNR as they age. It is normal to think about your own end-of-life care as you get older. If you're having trouble deciding whether to get a DNR order and want some help making up your mind, talk to your healthcare provider and family members. 

If you are a caregiver, gently encourage talking about end-of-life plans with your loved one or discuss your thoughts and concerns with their healthcare provider. These conversations can help you work through feelings about death and allow you to mentally process what you would like to see happen at the end of life.

The Difference Between Advanced Directives & Medical Orders

A DNR is just one part of a larger end-of-life plan, often called an "Advanced Directive." An Advanced Directive often contains a Living Will and Power of Attorney documents. These are all legal documents that go into detail about what kind of care a person wants in certain medical situations and at the end of life. You can state in your Advanced Directive documents whether you would like to be resuscitated and go into more detail about different measures you would or would not like to be taken. However, a valid DNR is a specific legal document regarding the use of CPR that must be signed by your physician. 

The biggest difference between a medically ordered DNR and an advanced directive is the purpose of each document. Medical-ordered DNRs are used by healthcare providers to indicate that you do not want any resuscitation measures performed should you require CPR. Advanced directives, on the other hand, are used by doctors and other professionals working with your legal team in order to determine what kind of end-of-life care will be provided.

How to Decide If a DNR Is Right For You

If you're considering a DNR, it's helpful to think about your own values and priorities as well as where you are in terms of your health. While talking with family members and friends can be helpful, keep in mind that everyone has different opinions about end-of-life care - and these differences are okay! The most important thing is that everyone feels supported in their choices while they're still alive, so they don't regret them later on.

Whether you've decided for or against having a DNR, ask yourself: What was the thought process behind this decision? Was it based on any particular experiences with death? What would make someone change their mind?

Some people worry that a DNR implies they are "giving up." Don't confuse a DNR with suicide or giving up on life. Do Not Resuscitate (DNR) orders are not requests for the end of life but rather plans for how you would like your health care providers to treat you in certain situations. Having these advanced directives in place protects your loved ones from emotional strain during a time of grief and provides peace of mind during the end-of-life process.