Do Not Resuscitate (DNR) Orders

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A do-not-resuscitate (DNR) order is another tool that helps medical providers honor their patients' wishes about end-of-life-care. Many questions are raised about DNR orders, and a great deal of confusion exists. What are they? How do you get one? Should everyone have one who has a living will? Does it take the place of a living will? What happens if you don't have one? This section attempts to answer these questions and to clear up some of the confusion that surrounds DNR orders.

What is a DNR order?

A DNR order is issued by a patient's doctor stating that if the patient's heart should stop beating, or if the patient should stop breathing, no effort should be made to resuscitate him.

How do you get a DNR order?

Generally, a doctor writes a DNR order for patients who are terminally and incurably ill, or in a persistent vegetative state, and who do not want their life needlessly prolonged by resuscitation efforts.

What is the difference between a living will and a DNR order?

A living will is a patient's decision not to have his life prolonged by artificial means when there is no reasonable hope of recovery. Healthy people often have a living will because it allows them to make this decision in advance. The patient uses the living will to express his wishes about the end-of-life-care he wants.

A DNR order, on the other hand, is a medical order issued by the patient's doctor after it has been determined that the patient is dying or in a persistent vegetative state. He does not want to be resuscitated in the event his heart stops beating or if he stops breathing because such an action would only needlessly prolong his life. A DNR order is often entered after the doctors have determined that a patient's living will should be honored. However, a patient does not need to have a living will before a DNR order can be entered, although having a living will may simplify the process of obtaining a DNR order.

A living will and a DNR order are different documents that can work together, but one is not dependent upon the other. Your living will can be honored even if there is no DNR order entered into your medical record. A DNR order can be entered into your medical record even if you do not have a living will.

What happens if you have a DNR order?

A DNR order should be kept with the patient. If the patient is at home or in a nursing home, and his heart stops beating or he stops breathing, the DNR order will tell Emergency Medical Service (EMS) Personnel who are called not to resuscitate the patient. Of course, if the patient has a DNR order, EMS should not be called in the first place. However, family members sometimes panic and call for help when they see their loved one in distress. The DNR order helps make sure that the patient's wishes are honored.

What happens if you don't have a DNR order?

If your heart stops beating or you stop breathing and EMS is called, they will resuscitate you if you do not have a DNR order. For many people, this is a good thing because they recover and go on to live long and productive lives. Unfortunately, some people may end up on life support systems with no reasonable hope of recovery, and their families may question why they were resuscitated. It is the duty of EMS to resuscitate patients whom they are called to help. Unless the patient has a DNR order, EMS must try to resuscitate the patient.

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Prepared by Carol A. Schwab, J.D., LL.M., Professor and Extension Specialist, NC State University.

This publication is provided as a public service and is designed to acquaint you with certain legal issues and concerns. It is not designed as a substitute for legal advice, nor does it tell you everything you may need to know about this subject. Future changes in the law cannot be predicted, and statements in this publication are based solely on the laws in force on the date of publication.

Date: October 2001