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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.
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?
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 Advance Directives: Do Not Resuscitate 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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