What is DNR?

Along with ‘Do Not Resuscitate’ (DNR), ‘no code’, ‘allow natural death’, and ‘comfort care only’ are terms used to describe one of the most important medical decisions that a person can make. Recognizing this, the topics of life, death, and self-determination have been the subject of much philosophical and religious thought for millennia. With advances in modern medicine, the decision of whether to prolong one’s life has become an issue most families must confront.

In the United States, DNR or ‘Do Not Resuscitate’ orders are respected instructions given by a patient’s physician or authorized healthcare provider to healthcare personnel that the patient should not receive any attempt of cardiopulmonary (heart and lungs) resuscitation if breathing stops, or the heart stops beating. Although the concept of patient autonomy is accepted by healthcare providers, there are many circumstances in which the decision of life or death falls on the shoulders of the healthcare team.

How is DNR Categorized?

In general, a DNR occurs when a patient exercises their right to refuse certain medical interventions to save their life. In the United States, there are two types of DNR: In an ‘inpatient’ DNR, the medical professionals in the hospital write the DNR order and agree to honor it. In an ‘outpatient’ DNR, the patient or their healthcare proxy signs the DNR order and usually keeps it with them in their home or a healthcare setting. This ensures that the order is honored if the patient’s heart or breathing stops.

What are the Reasons for DNR?

The most common reasons for DNR orders are advanced age or progressive illnesses, such as stroke, cancer, Parkinson’s, Alzheimer’s, or other chronic conditions that cause extreme physical or mental disability. In cases such as these, cardiopulmonary resuscitation (CPR) is unlikely to be effective and may also cause physical trauma. Other times, a patient may make the decision not to receive CPR even if it is likely to be effective. This decision may be based solely on a personal belief or preference.

The decision to initiate a DNR order is a very personal decision and should be discussed with the patient’s healthcare team. The patient or the healthcare proxy should make sure that all medical personnel are clear on the patient’s wishes and that they understand any potential risks and benefits of a DNR order. Ultimately, all decisions regarding a patient’s healthcare should be respected.