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Do Not Resuscitate

(DNR)

 


Overview

 

A do-not-resuscitate order (DNR) is a set of instructions that tell your healthcare team what kind of care you do and don’t want at the end of your life. This is a legal and medical document, and it ensures that your end-of-life medical care aligns with your beliefs, needs and desires as closely as possible.

 

A DNR does not apply to other treatments, such as pain relievers and antibiotics, because you are still entitled to palliative care.

 


What is a do-not-resuscitate order?

 

A do-not-resuscitate (DNR) order is a type of advance directive. Having a DNR order means you don’t want treatments like cardiopulmonary resuscitation (CPR) used on you if your heart or breathing stops.

Under ordinary circumstances, healthcare providers will do everything they can to try to save your life.

That can include CPR and other treatments like:

  • Chest compressions: This is what most people call CPR. It’s a technique that uses repeated, forceful compressions of the chest to keep the blood pumping through the body when the heart is not working.
  • Defibrillation: This treatment uses electricity to try and restart the heartbeat. This electric shock can be delivered through handheld paddles or pads that stick to the chest.
  • Intravenous (IV) medications: Providers use many medications during resuscitation. Some of them are powerful medications, like epinephrine, that aim to get the heart beating again. But this is just one of many IV medications that someone may get when receiving chest compressions.
  • Supporting breathing: The heart gets most of the attention during a cardiac arrest. But during resuscitation, it’s important to keep oxygen flowing in and carbon dioxide flowing out. Placing a mask and inflatable bag over someone’s mouth can accomplish this. It can also be done with intubation.

But what if you’re already very sick or have a terminal illness? That’s where DNR orders come in.

They can help if you want any of the following:

  • To limit any pain or suffering you have as you near death
  • To preserve your dignity at the end of your life

A healthcare provider usually writes a DNR order after a discussion with you and/or any legal decision-makers or loved ones you want present. Depending on the law where you live, a DNR is only valid if written by a physician (MD or DO) or another specified type of healthcare professional.

Ideally, you’d have a do-not-resuscitate order prepared before an emergency happens. The order tells healthcare providers not to try CPR if your heart stops beating or your breathing stops. The provider who writes the order adds it to your medical chart for other medical professionals to see.

 

Purpose of a DNR order:

DNR orders serve several important purposes, including:

  • Respecting patient autonomy: DNR orders honor a patient's wishes when they have expressed a desire to avoid CPR, especially when facing a terminal illness or irreversible condition.
  • Preventing unnecessary interventions: In some cases, CPR may not align with a patient's goals of care, and DNR orders ensure that unwanted and potentially invasive life-saving measures are not performed.
  • Focusing on comfort care: DNR orders prioritize comfort, pain management, and quality of life over aggressive life-sustaining measures in certain medical scenarios.

 

 


What are the types of DNR?

 

Most of the time, a DNR refers to CPR and related treatments like using a defibrillator. But there are other, similar orders that are more specific. And sometimes, the law where you live can affect the types of available DNRs.

Some examples of different DNR types include:

  • Do not attempt resuscitation (DNAR). This is basically the same as a DNR. But some places or healthcare organizations use this term instead.
  • Allow Natural Death (AND). This lets providers use treatments that keep you as comfortable as possible. The goal here is to prevent suffering as you die.
  • Do not intubate (DNI). This lets providers know you wouldn’t want placement of a breathing tube or to be on a ventilator if you can’t breathe on your own.
  • Specified DNRs. These are tailored DNRs. For example, you might specify that you don’t want CPR. But healthcare providers can still use other treatments, like a defibrillator, to try to save your life.
  • Comfort care orders. These may specify what kind of care providers can use near the end of your life. They also communicate your wishes in the context of keeping you as comfortable as possible as your life ends.

There might be other variants or types of DNRs available depending on where you live and your situation. Your healthcare provider can tell you more about your options.

 


What is Resuscitation?

 

 

CPR is the treatment you receive when your blood flow or breathing stops. It may involve:

  • Simple efforts such as mouth-to-mouth breathing and pressing on the chest
  • Electric shock to restart the heart
  • Breathing tubes to open the airway
  • Medicines

 


Why would anyone want a DNR order?

 

Patients tend to go for DNR orders when they suffer from a terminal disease such as cancer or dementia. The patient may choose a DNR order whenever there is a poor prognosis and a lower survival rate with a higher chance of heart, lung, or brain damage if resuscitation is done. Some patients decide to have a DNR order because they do not want to be on life support when their time is running out because the possibility of pain and harm from CPR is frequently greater than the benefits.

Some people with terminal illnesses or serious medical conditions might not want to undergo CPR, even if that means they might die as a result. Deciding to have a DNR order can empower you by making you feel more in control of your own life.

Although CPR can save lives, it isn’t 100% successful. And for people who are very sick or have certain conditions, the odds of success can be much lower. It’s also common to have painful injuries from CPR, like broken ribs and sternum fractures.

 


Process of a DNR order:

Establishing DNR orders involves a structured process:

  • Informed consent: Healthcare providers must have discussions with patients or their authorized decision-makers to explain the risks, benefits, and alternatives of CPR. This ensures that the decision aligns with the patient's values and goals.
  • Documentation: DNR orders are documented in the patient's medical records, typically as a formal medical order signed by a healthcare provider.
  • Communication: Clear communication among the healthcare team, the patient (if capable of making decisions), and the patient's family or designated decision-makers is crucial to ensure that everyone understands the plan of care.
  • Regular reassessment: DNR orders should be periodically reassessed to determine whether the patient's wishes or clinical condition have changed. Reevaluation ensures that the care plan remains consistent with the patient's goals.

 


Benefits of Having a DNR Order

 

Family members and close friends of someone who has created a DNR order may not fully understand why anyone would not want life-saving treatment, but there are a number of benefits that come with having a DNR. 

  • Respect the patient’s end-of-life wishes: Having a DNR allows the patient to have more control over their medical decisions and body, especially when illnesses can take that away.

  • Reduces healthcare costs: The sad reality of healthcare in the U.S. is that many people are in debt because of medical costs. For some, having a DNR can reduce those costs and bring a level of financial peace. Receiving treatment while worrying how you’re going to pay for it can be a very stressful situation.

  • Enhances comfort: Having a DNR order can help improve the patients quality of life by avoiding any unnecessary pain from last-chance medical treatments and interventions.

  • Promotes natural death: By not having aggressive life-saving treatments, patients can pass away peacefully in their own time, surrounded by their loved ones.

  • Helps family decision-making: Having a DNR can help ease the burden of family members having to make difficult decisions about their care during a crisis. This stress is removed completely. 

 


Making the Decision

 

If you are near the end of your life or you have an illness that will not improve, you can choose whether you want CPR to be done or not.

  • If you do want to receive CPR, you do not have to do anything.
  • If you do not want CPR, talk with your provider about a DNR order.
  • Either way, it is best to discuss your desires with your providers and family before it becomes an urgent decision.

These can be hard choices for you and those who are close to you. There is no hard and fast rule about what you may choose.

Think about the issue while you are still able to decide for yourself.

  • Learn more about your medical condition and what to expect in the future.
  • Talk to your provider about the pros and cons of CPR.

A DNR order may be a part of a hospice care plan. The focus of hospice care is not to prolong life, but to treat symptoms such as pain or shortness of breath, and to maintain comfort.

If you have a DNR order, you always have the right to change your mind and request CPR if necessary.

 


Are there DNR pros and cons?

 

Making the decision of whether or not to be resuscitated may not be easy for your loved one. It is also one that can change with one’s stage of life or health.

Consider these examples:

  • Your loved one is healthy, active, and likely to live independently for several years or more.
  • A person who has had a rapid health decline, including the onset of one or more serious illnesses.
  • A young person who was injured and is now in a coma with little chance of recovery.

In each of those situations, your loved one, or you as a healthcare proxy, makes resuscitation decisions.

DNR pros include:

  • Making a choice around a DNR order while your loved one is still in a good state of mind.
  • Making sure the decision relieves loved ones of having to decide.
  • Your loved one’s choice is clear to emergency and medical personnel.
  • Your loved one can revoke the DNR order at any time.

DNR cons include:

  • Arguments can arise if family members disagree about your loved one’s decision.
  • A DNR for the community may not apply when your loved one is admitted to the hospital.
  • Some sources suggest that having a DNR can cause risks and the potential for less care for patients.

 


Why does someone choose a do not resuscitate order?

 

People have different reasons for choosing a DNR. Here are examples of why your loved one may or may not choose one.

  • A DNR is for your loved one if:
    • They want to make the decision, rather than leaving it to others.
    • They are nearing life’s end.
    • They have a serious or terminal illness and do not want CPR if their heart or breathing stops.
    • They are about to have surgery that includes life-threatening risks.
  • A DNR is not for your loved one if:
    • They are unsure and trust others to make the right decision for them.
    • They are healthy, vital, and likely to live for many years.
    • They want to have CPR if their heart or breathing stops.
  • Your loved one’s DNR order can be activated at any time and anywhere.
    • The need for resuscitation can happen out in the community where first responders come to the rescue.
    • A hospital will ask about resuscitation wishes when your loved one is admitted to the hospital. Resuscitation can happen when your loved one is at the hospital as either an in-patient or out-patient.
    • Because of events like these, your loved one’s DNR needs to be kept on hand when out and about.



What if I change my mind after a DNR order is written for me?

 

You always have the right to change your mind with regard to your DNR. If you do change your mind, tell your healthcare provider immediately so they can note the change in your medical record. You should also stop carrying any wearable items like ID bracelets and destroy any paper copies you have.

Tell your loved ones and other caregivers that you’ve changed your mind and your DNR is no longer what you want.

 


What happens if you resuscitate a DNR patient?

 

DNR orders only apply to medical professionals who know (or should reasonably know) about it. If a healthcare provider doesn’t know about your DNR or there’s a miscommunication, they won’t necessarily get into trouble.

But if your healthcare provider resuscitates you and they know about your DNR, they can face legal consequences. They can also face consequences if they don’t know about your DNR due to negligence.

Nonmedical professionals can’t get into any kind of legal trouble for performing CPR on a person with a DNR. If you’re trained in CPR, you should attempt it on a person experiencing cardiac arrest. But if a situation arises where you know that the person has a DNR, you should respect their wishes not to be resuscitated.

 


How is a DNR Order Created?

 

 

 

 

 

 

If you decide you want a DNR order, tell your provider and health care team what you want. Your provider must follow your wishes, or:

  • Your provider may transfer your care to a provider who will carry out your wishes.
  • If you are a patient in a hospital or nursing home, your provider must agree to settle any disputes so that your wishes are followed.

Your provider can fill out the form for the DNR order.

  • Your provider writes the DNR order in your medical record if you are in the hospital.
  • Your provider can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings, so that emergency medical personnel will be able to understand your DNR status.
  • Standard forms may be available from your state's Department of Health.

Make sure to:

  • Include your wishes in an advance care directive (living will)
  • Inform your health care agent (also called health care proxy) and family of your decision

If you do change your mind, talk with your provider or health care team right away. Also tell your family and caregivers about your decision. Destroy any documents you have that include the DNR order.

Does each state have their own DNR laws?

Each state has laws and requirements as shown at the bottom of this page.

Your loved one’s doctor is up-to-date with state laws and has forms available in their office.

 


What Are the Rules for DNR Order?

 

DNR orders vary from state to state, particularly regarding out-of-hospital care like an ambulance. Some states have standardized forms; if the order is not written on that, it cannot be considered. Some states are less concerned and honor any clear DNR order. Despite the format or the state, DNR orders follow the same general rules always; to be valid.

  • A doctor should write it rather than state it verbally. There are some exceptions to this rule, such as an emergency physician can order an ambulance crew to stop or withhold resuscitation over the phone.
  • A doctor should sign it. In cases where a nurse takes orders over the phone, the doctor has a deadline to verify and sign the declaration physically.
  • Should include the patient's name and date. Orders may expire after a stipulated period of time, or the doctor may have a deadline to follow up.
  • Even if a DNR order is not expired, especially in older patients, an order may evoke a caregiver to revisit the decision.
  •  


When You are Unable to Make the Decision

 

Due to illness or injury, you may not be able to state your wishes about CPR.

In this case:

  • If your provider has already written a DNR order at your request, your family may not override it.
  • You may have named someone to speak for you, such as a health care agent. If so, this person or a legal guardian can agree to a DNR order for you.

If you have not named someone to speak for you, under some circumstances, a family member can agree to a DNR order for you, but only when you are not able to make your own medical decisions.

 


How does a DNR affect my care if I’m having surgery?

 

If you have a DNR and need to undergo surgery, be sure to talk about your DNR with your surgeon and your anesthesiologist. They can tell you more about how your DNR might affect any part of your surgery or procedure.

In some cases, your anesthesiologist, surgeon or both may ask you to suspend your DNR during your surgery. That’s because some of the routine parts of surgery, especially general anesthesia, might conflict with your DNR. If you have any questions about this, don’t hesitate to ask your surgeon or anesthesiologist. Making sure they understand your concerns is a vital part of making sure you get care that aligns with your needs and wishes.

 


How do I make my wishes known about a DNR?

 

Talk to your primary care provider or the main provider leading your care team. Your healthcare provider will discuss the benefits and risks of CPR and related types of care. This is meant to be a frank conversation with you about what exactly you want. Informed consent is vital in these conversations so you can make a choice based on all the facts and your personal preferences. And if you need to think about it or talk about it further with loved ones, it’s okay to tell your provider that. It’s also common for healthcare providers to ask about a DNR order during office visits or when you’re admitted to the hospital.

Once you have a DNR, your provider can file it with your medical record. They can also give you a copy to carry with you. You can also find wearable medical ID bracelets that notify first responders that you have a DNR.

Print a copy of the Outside the Hospital Do-Not-Resuscitate (OHDNR) Order for your use

Print a copy of the Do-Not-Resuscitate (DNR) Order Form for your use

 


Ethical Considerations:

 

The inconsistent application of DNR orders indicates that some patients may receive lesser care once healthcare providers are informed of the DNR order. A DNR order does not mean withholding all the treatment. It is just an order not to revive. Even the hint of DNR can result in many untoward reactions. Therefore, discuss the options with the doctor and family when everyone is calm and rational, hopefully sooner rather than later.

While analyzing perioperative DNR orders, four ethical concepts are essential.

  • Patient autonomy: Respecting a patient's autonomy is paramount when making decisions about DNR orders. Healthcare providers must ensure that patients have the capacity to make informed choices or rely on authorized decision-makers when patients cannot express their preferences.
  • Beneficence and non-maleficence: Healthcare providers must weigh the potential benefits and harms of CPR. DNR orders aim to prevent unnecessary suffering and invasive procedures while promoting the patient's best interests.
  • Shared decision-making: Collaborative decision-making involving the patient, healthcare providers, and the patient's family or designated decision-makers ensures that the DNR order aligns with the patient's values and goals.
  • Cultural and religious considerations: Cultural beliefs and religious values may influence a patient's decision regarding DNR orders. Healthcare providers should be sensitive to these factors and provide culturally competent care.

     


One Final Note..

 

Even when the end of your life is near, you still have a say in the care that you receive. Do-not-resuscitate orders empower you and let you choose the types of care that you’ll receive.

It’s a good idea to talk to your healthcare provider about what you want for end-of-life care long before you ever need it. Planning ahead helps ensure your healthcare team and loved ones know what you want. That way, you can receive care that aligns with your needs and priorities right up until the end.

A patient may have difficulty discussing a DNR order and feel like giving up. Patients can take charge of their end-of-life plans while still being able to do so and understand the rules governing DNR orders. Even if patients opt for a DNR order, they have the right to change their minds, reverse the order, and request CPR.

 


Do Not Resuscitate (DNR) Laws by State

2025

 

State DNR Law Specifics
Alabama The Alabama do not resuscitate (DNR or DNAR) order form allows a patient to avoid treatment should their heart or brain show no electrical activity. DNRs must be requested by the individual/patient (or by a health care proxy, surrogate, or attorney if they are incompetent) and their physician.
Alaska The Alaska do not resuscitate (DNR) order form is primarily used by individuals who are in the late stages of a terminal disease and do not want to be brought back to life if they die. The form may only be obtained from a licensed physician practicing in the State of Alaska.
Arizona Arizona law A.R.S. §36-3251 authorizes the Prehospital Medical Care Directive, which is commonly referred to as the Do Not Resuscitate or “DNR” form. As the name indicates, the DNR instructs certain medical personnel to forgo resuscitation if the patient stops breathing or if the patient’s heart stops beating.
Arkansas The Arkansas do not resuscitate (DNR) order form is a document used by an individual who does not wish to receive any resuscitation procedures in the event of a medical emergency. Typically, a DNR is ordered by people who are terminally ill, or who are against receiving life-prolonging treatment when close to death.
California The California do not resuscitate order form (DNR) is a document that, when signed by a patient and their physician, will prevent EMTs, paramedics, and other emergency personnel from performing any medical procedures on an individual if their heart stops beating or they stop breathing.
Colorado Colorado law recognizes the right of an individual to accept or refuse medical treatment, including cardiopulmonary resuscitation. An individual with decision-making capacity or his/her authorized agent may use a CPR Directive to exercise the right of informed refusal of cardiopulmonary resuscitation.
Connecticut A valid DNR order can only be written by a Connecticut licensed physician.
Delaware An individual/patient who does not wish to be resuscitated in the event of cardiac arrest has the right to make this decision, and for this reason, a DNR section is integrated within the DMOST form for this purpose.
District of Columbia A Washington DC Medical Orders for Scope of Treatment (MOST) form is a legal document that allows people to work with physicians to make critical decisions about end-of-life care and ensure that their wishes are respected even if they are no longer conscious. The district once used “Do Not Resuscitate” orders, commonly known as “DNR” forms, but the district eliminated them in favor of MOST forms in 2015. The forms contain corresponding to types of treatment—including CPR, provision of antibiotics, and medically assisted nutrition—in which the patient may select whether the treatment is desired and, if so, the degree of intervention that should be provided; if a section is left blank, medical personnel will assume that the person desires full intervention.
Florida A Florida do not resuscitate order form (DNR or DNRO) is a document that is used by residents of Florida who suffer from incurable or irreversible medical conditions. This form states that the requester does not wish to be resuscitated in the event of respiratory or cardiac arrest.
Georgia The Georgia do not resuscitate (DNR) order form is a document requested by an individual who does not wish to have any resuscitation procedures performed on them in the event of cardiac or respiratory arrest. This form is reserved for patients who have a medical condition which, upon the use of CPR or other resuscitation procedures, would result in imminent death.
Hawaii A Hawaii do not resuscitate (DNR) order is no longer its own form but a clause within Hawaii’s Provider Orders for Life-Sustaining Treatment (POLST) Form. The POLST form allows citizens of the State to have more control over the type of treatments and medical procedures they will receive towards the end of their lives.
Idaho The Idaho do not resuscitate (DNR) order form has been integrated into a standardized form featuring a wider range of options concerning medical treatments and procedures for patients with terminal/serious illnesses. The POST form contains sections regarding medical interventions, artificial nutrition, and, of course, resuscitation procedures. Typically, refusing CPR and other forms of resuscitation is reserved for the terminally ill or individuals who suffer from a condition which, with the added strain of CPR, would lead to imminent death.
Illinois An Illinois do not resuscitate (DNR) order form can be requested by residents of Illinois who wish to avoid CPR and other resuscitative procedures in the event that their heart or breathing stops.
Indiana The patient’s physician must approve of a DNR, confirming the patient’s condition by signing the DNR form. Aside from the patient’s and physician’s signatures, two (2) witnesses are required to make a DNR order valid. Required to Sign – Patient, physician and two (2) witnesses.
Iowa The Iowa do not resuscitate (DNR) order form is a type of advance directive certified by a patient’s physician alerting all medical personnel that resuscitative procedures are not to be used in the event that the patient’s heart or breathing stops.
Kansas A Kansas do not resuscitate (DNR) order form is a document stating a person’s decision not to have any resuscitative procedures administered by medical personnel should their heart or breathing stop. Although a patient who requests a DNR will not be given CPR or other such procedures, they may be provided non-resuscitative comfort-related medical care.
Kentucky It is the full responsibility of the patient, or their authorized representative, to request a DNR order; a physician is not required to provide confirmation of their patient’s health status. Required to Sign – patient and a notary public or two (2) witnesses not related to the patient.
Louisiana A Louisiana Do Not Resuscitate (DNR or DNAR) order form instructs any medical professional dealing with a patient not to resuscitate them in the event that they enter cardiac arrest. This document is issued by the patient’s doctor after consulting with the patient or their authorized representative.
Maine The Maine do not resuscitate (DNR or DNAR) order form is a document which doctors provide to patients who do not want to be resuscitated in the event that their breathing or heartbeat stops. Once the patient has filled out the document and both they and the doctor have signed the order, it will be added to their medical record. Such an order may also be requested when a patient is admitted to a hospital. A DNR Order must be honored by all medical personnel and exempts said personnel from any litigation for not administering life-saving procedures.
Maryland A Maryland do not resuscitate (DNR or DNAR) order form is a document used by a patient to provide instructions not to resuscitate in the event of a cardiac or respiratory arrest. This document may be obtained from the patient’s doctor or upon entry to a hospital.
Massachusetts A Massachusetts do not resuscitate (DNR or DNAR) order form is a document that patients may obtain from their doctors if, for personal or health-related reasons, they do not wish to be resuscitated. This document, which may be signed on behalf of the patient by an authorized representative, parent, or legal guardian, indicates that cardiopulmonary resuscitation (CPR) will not be used in the treatment of said patient unless the DNR order is revoked by the patient or their representative.
Michigan A Michigan do not resuscitate (DNR or DNAR) order form is a document issued by an individual in order to alert medical staff that, in the event of a cardiac arrest, they do not want to be resuscitated by CPR or other means.
Minnesota The Minnesota do not resuscitate (DNR or DNAR) order form translates the wishes outlined in an individual’s health care directive into a medical order. A DNR order specifically orders that if the subject’s heartbeat or breathing stops, CPR should not be administered. Once issued, the document will be kept in the patient’s medical record to ensure that medical personnel know how the patient wishes to be treated. The patient or their representative may revoke the DNR order at any juncture by informing their health care provider that they wish it to be revoked.
Mississippi A Mississippi do not resuscitate (DNR) order is used by a patient upon being admitted to any hospital in the State. This document directs the attending medical professionals to not resuscitate the patient if they have a cardiac or pulmonary arrest. The DNR order will be provided to the patient and filed in the patient’s medical record.
Missouri The Missouri do not resuscitate (DNR) order form is a document that a patient fills out if they do not want life-saving procedures to be implemented in the event that they have a cardiac or respiratory arrest. The DNR order form, once completed, will be placed as the first page of the patient’s medical record in order to notify medical personnel of the patient’s wishes.
Montana The Montana do not resuscitate (DNR) order has been replaced by the Provider Orders for Life-Sustaining Treatment (POLST). A DNR order is a document that is inserted into a patient’s file declaring that said patient wishes that no cardiopulmonary resuscitation (CPR) is applied if they stop breathing or their heart stops. These orders are usually requested by individuals who are already in critical condition or who are incurable. The DNR order is found in Section A of the POLST document, which provides several other end-of-life and critical treatment options.
Nebraska A Nebraska do not resuscitate (DNR) order form is placed into a patient’s medical record when the patient does not wish to be resuscitated in the event of a cardiac or respiratory arrest. Such orders must be filled out by the patient and signed by at least one (1) witness and a licensed physician.
Nevada A Nevada do not resuscitate (DNR) order form is a document that instructs medical personnel not to administer cardiopulmonary resuscitation (CPR) to the patient if their heartbeat and/or breathing stops. To issue a DNR order, the subject, or their authorized health agent, must obtain, fill out, and sign a DNR Application Form from their physician, who must also sign.
New Hampshire The New Hampshire do not resuscitate (DNR or DNAR) order form is a document used by a patient to record their wishes regarding resuscitation in the event of cardiac or respiratory arrest. This document will be printed on pink paper and put in their medical record. A DNR order is often issued to people who are at risk to enter into a vegetative state if they receive CPR or who are already in a coma.
New Jersey A New Jersey do not resuscitate (DNR or DNAR) order form is issued by a physician by the request of a patient who is in their care. If the patient is unable to communicate or to understand the repercussions of a DNR order, a person authorized to make healthcare decisions on their behalf is permitted to sign their DNR order.
New Mexico A New Mexico do not resuscitate (DNR or DNAR) order form is issued by a physician on behalf of an adult resident (18 years of age or older) after they have properly explained its significance to the patient. One (1) signed copy of a DNR order should be kept by the patient and another copy kept by the physician, filed in the patient’s medical record. If the patient would like a DNR bracelet, they will need a third copy of their DNR order and to enroll in MedicAlert with their physician’s assistance. At any point, the order may be revoked by the patient or an authorized representative’s verbal command, or by being physically destroyed. If a DNR order is revoked, the patient’s physician should be informed immediately.
New York The New York Medical Orders for Life­ Sustaining Treatment (MOLST) helps to specify a patient’s wishes regarding life-sustaining treatments and is often used by those who are in the critical stages of an illness or old age. If a MOLST is indicated in the patient’s medical record, they will not be given cardiopulmonary resuscitation (CPR) in the event of a cardiac/respiratory arrest. This form details multiple aspects of end-of-life care and is recognized by all healthcare professionals in the State.
North Carolina The North Carolina do not resuscitate (DNR or DNAR) order form serves residents who wish to order medical personnel not to administer CPR on them if they have a cardiac or respiratory arrest. In accordance with the Right to Die a Natural Death Act (Article 23), a declaration to disallow the use of CPR or other life-prolonging measures can be made by anyone who suffers from an irreversible condition, or who becomes permanently unconscious or suffers from a substantial loss of cognitive ability. This type of declaration, or advanced directive, must be signed in the presence of two (2) witnesses and notarized.
North Dakota A North Dakota do not resuscitate (DNR) order form is used to inform medical personnel that a patient does not wish to receive cardiopulmonary resuscitation (CPR). This type of order is often requested by patients suffering from end-stage medical conditions that, at the time their breathing or heart stops, would rather die naturally than have their life restored through invasive and painful resuscitation methods. A DNR order can be obtained from the patient’s doctor or other authorized health care providers.
Ohio An Ohio Do Not Resuscitate (DNR) Order Form tells emergency medical service providers and other health care professionals that a patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. A patient with a DNR order in place will receive general care to alleviate pain such as oxygen and pain medication, though no life-saving or life-prolonging treatments will be administered. The DNR order may be executed by the patient, by an authorized representative acting on the patient’s behalf, *or under the conditions of the patient’s living will. Two (2) physicians, physician assistants or advanced practice nurses must certify the individual as being in a permanently unconscious state, terminally ill, or both.
Oklahoma The Oklahoma do not resuscitate (DNR) order form specifies a person’s choice to reject cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. A patient who voluntarily executes a DNR form, or who has an authorized representative complete the document on their behalf, will not be resuscitated by health care providers but will instead be allowed a natural death. The DNR order is valid immediately after it is signed by the patient and two (2) witnesses who are eighteen (18) years of age or older and who are not named in the patient’s will.
Oregon An Oregon do not resuscitate (DNR) order form is used to notify medical staff that a patient does not wish to receive cardiopulmonary resuscitation (CPR) when experiencing a medical emergency in which no pulse or breathing is reported. Without a DNR order in place, health care providers will have the responsibility of performing CPR in an attempt to save the patient’s life. The DNR order can be requested from the patient’s doctor or from another authorized individual. The order shall be signed by the patient and the authorized medical professional.
Pennsylvania A Pennsylvania do not resuscitate (DNR) order form provides an individual with the ability to avoid life-saving treatments in the event that they experience cardiac or respiratory arrest. The DNR is valid once signed by the patient (or authorized representative) and the patient’s physician. Subsequently, if EMS providers attend to the patient and view the DNR, or if they see the patient’s DNR necklace or bracelet, CPR will not be attempted and the patient will die naturally. A doctor or other medical professional will be able to provide the official document, though a sample DNR form is available below.
Rhode Island A Rhode Island medical order for life-sustaining treatment (MOLST) alerts health care professionals that a patient does not wish to be brought back to life through the administration of cardiopulmonary resuscitation (CPR). This type of medical order will only be effective during an emergency where the patient’s heart or breathing stops. The attending health care professional must view the MOLST order immediately or resuscitative measures will be performed.
South Carolina The South Carolina do not resuscitate (DNR) order form is a notice informing emergency medical service providers that no resuscitative measures shall be administered to a patient in the event they experience cardiopulmonary arrest. A DNR order may be requested by the patient or from a representative authorized to make medical decisions on their behalf (i.e., surrogate or agent). Furthermore, the order may only be executed if a physician has determined that the patient suffers from a terminal condition.
South Dakota The South Dakota do not resuscitate (DNR) order form instructs emergency medical personnel to withhold the administration of cardiopulmonary resuscitation (CPR) to a patient whose heart or breathing has stopped. This type of medical order is often requested by individuals who would prefer to die naturally and avoid the suffering of resuscitative treatments. The DNR form or bracelet must be present at the time of an emergency or else the attending medical staff will be required to resuscitate the individual. Therefore, the DNR order/bracelet should be kept close to the individual and made easily accessible.
Tennessee The Tennessee do not resuscitate (DNR) order form informs emergency medical service providers that no cardiopulmonary resuscitation (CPR) should be initiated on a patient. An applicant for a Tennessee DNR order must be diagnosed with a terminally ill condition in order for the attending physician to execute the form. Once the form is effective, the patient will not be resuscitated in the event of a medical emergency where their breathing or heart ceases to function.
Texas A Texas do not resuscitate (DNR) order form can be used by a patient to willfully decline life-saving treatments when their heart or lungs cease to function. The order informs emergency medical personnel that the individual does not wish to receive cardiopulmonary resuscitation (CPR), defibrillation, artificial ventilation, transcutaneous cardiac pacing, and advanced airway management. Medical staff attending to a patient during an emergency must view the DNR order or else resuscitative treatments will be applied. Two (2) competent adults must witness the signatures provided by the patient or their authorized representative. If the patient or representative is incapable of signing, the witnesses must witness the nonwritten communication made to the attending physician. Optionally, a notary public may be present when the document is executed. 2023’s Texas HB3162 would have a given more clarification to the patients’ DNR orders, but it died in committee.
Utah A Utah do not resuscitate (DNR) order form tells emergency medical personnel not to attempt cardiopulmonary resuscitation (CPR) on a patient who is experiencing cardiac or respiratory failure. The patient can verbally request a DNR order from their physician, or they can make a written request in their advance directive or living wil. A more comprehensive version of a DNR form has recently been implemented in Utah. This document, known as the “POLST” form (Provider Order for Life-Sustaining Treatment), informs emergency medical service providers of the patient’s desired resuscitative treatments, as well as medical interventions to be applied when the patient maintains a pulse and/or can still breathe.
Vermont The Vermont do not resuscitate (DNR) order form details the end-of-life resuscitative treatments which should be applied to a patient when they experience respiratory or cardiac arrest. The DNR order instructs emergency health care providers to withhold the administration of cardiopulmonary resuscitation (CPR) as desired by the patient or their legal representative. Furthermore, the form may be used to define the medical interventions necessary to maintain the patient’s health and comfort when they can still breathe or when their heart is still beating (e.g., feeding tube, fluids, antibiotics). The patient’s clinician must be consulted when preparing the document.
Virginia The Virginia do not resuscitate (DNR) order form is a statement that lets emergency service personnel know that a patient does not want to receive life-saving treatment during a respiratory or cardiac arrest. Life-saving treatments include cardiopulmonary resuscitation (CPR), endotracheal intubation, cardiac compression, and certain airway management procedures. The order must be issued to the patient by a licensed physician who has established a relationship with the individual. Once the form is signed by both the physician and the patient (or their authorized representative), the DNR order will be effective and the individual will be exempt from resuscitation by any medical professional.
Washington The Washington physician orders for life-sustaining treatment (POST) provides medical professionals with instructions not to apply life-saving treatments to an individual experiencing cardiac or respiratory arrest. A patient with a POST order will not receive cardiopulmonary resuscitation (CPR), though standard therapeutic procedures will still be administered. It will be necessary for the order to be signed by both the attending health care professional and the patient (or their authorized representative) before the document will be valid. Once signed, the document should be kept close to the patient and made easily accessible to the emergency medical staff.
West Virginia The West Virginia do not resuscitate (DNR) order form is a written directive stating that a person does not wish to receive cardiopulmonary resuscitation (CPR) when they die. This type of medical order is often requested by terminally ill patients whose health would not benefit from resuscitative treatments. A patient may request a DNR from their physician unless they lack the mental capacity to do so. In these instances, the patient’s legal representative (if any) may act on their behalf.
Wisconsin The Wisconsin do not resuscitate (DNR) order form is used to notify emergency medical personnel that an individual should not receive life-saving treatments to restore their circulation or breathing. A patient who qualifies for a DNR order must have a terminal medical condition that would not benefit from resuscitation as determined by a licensed physician. If the patient is approved for a DNR order, the physician must complete the document below and request an identifying DNR bracelet; emergency personnel will not honor the DNR order unless a DNR bracelet accompanies the patient.
Wyoming The Wyoming do not resuscitate (DNR) order form is a legal document that instructs medical service providers to withhold the application of cardiopulmonary resuscitation (CPR) on a patient who is not breathing or has no heartbeat. An individual may voluntarily request a DNR order from their doctor, or if they cannot make medical decisions on their own, a legal representative may ask for the form on their behalf. Medical staff who view the DNR order must honor the patient’s instructions and allow them to die naturally.

 

State Laws & Signing Requirements

A DNR order is required to be authorized in accordance with state law.

State Signing Requirements Laws
Alabama Patient and Physician § 420-5-19-.02
Alaska Patient and Physician AS 13.52.150
Arizona Patient, Physician, and a Witness § 36-3251
Arkansas Patient and Physician § 20-13
California Patient and Physician PROB § 4780
Colorado Patient and Physician § 15-18.6-102
Connecticut Patient and Physician § 19a-580d
Delaware Patient and Physician § 2509A
Florida Patient and Physician FAC 64J-2.018
Georgia Physician § 31-39-(2-9)
Hawaii Patient and Physician § 327K-2
Idaho Patient and Physician § 39-4514
Illinois Patient, Physician, and a Witness 755 ILCS 40/65
Indiana Patient, Physician, and 2 Witnesses § 16-36-5.11
Iowa Physician § 144A.7A
Kansas Patient, Physician, and a Witness § 65-4943
Kentucky Patient and Either Two Witnesses or a Notary Public § 311.623
Louisiana Patient and Physician § 40:1155.3
Maine Patient and Physician § 93-A.1(b)
Maryland Physician § 5-608.1
Massachusetts Patient and Physician None
Michigan Patient, Physician, and Two Witnesses § 333.1053
Minnesota Patient and Physician Chapter 145C
Mississippi Patient and Physician § 41-41-302
Missouri Patient and Physician § 190.603
Montana Patient and Physician § 37:10
Nebraska Patient, Physician, and a Witness for DNR; Patient and Either Two Witnesses or a Notary Public for Declaration § 20-404
Nevada Patient and Physician § 450B.520
New Hampshire Patient and Physician § 137-J:26
New Jersey Patient and Physician N.J.A.C. 10:48B
New Mexico Patient and Physician § 7.27.6.8
New York Patient and Physician Senate Bill S7883
North Carolina Patient and Physician for MOST; Patient, Two Witnesses, and Notary Public for Declaration § 90-321 & § 90-322
North Dakota Patient and Physician for POLST § 23-06.5
Ohio Physician § 3701-62
Oklahoma Patient, Physician, and Two Witnesses § 63-3131.5
Oregon Physician for POLST § 847-035-0030(6) & § 847-010-0110
Pennsylvania Patient and Physician § 5481 – § 5488
Rhode Island Patient and Physician R23-4.11-MOLST
South Carolina Patient and Physician § 44-78-10 – § 44-78-65
South Dakota Patient and Physician ARSD 44:05:06 & SDCL 34-12F
Tennessee Patient and Physician for POST § 68-11-224
Texas Patient, Physician, and Either Two Witnesses or 2nd Physician § 157.25 & Chapter 166
Utah Patient and Physician (2nd Physician Required for Minors) R432-31
Vermont Patient (if able to sign) and Physician § 9708 & § 9709
Virginia Patient and Physician § 54.1-2987.1
Washington Patient and Physician for POLST § 43.70.480 & § 70.245
West Virginia Patient and Physician for POST § 16-30C
Wisconsin Patient and Physician § 154.17 – § 154.29
Wyoming Patient and Physician § 35-22-501 – 35-22-509

 



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Copyright © 2000 - 2025    K. Kerr

Most recent revision April 24, 2025 05:32:46 PM