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If your heart or breathing stops and you can't speak for yourself, emergency personnel will assume you consent to treatment. They are legally obligated to do everything they can to restart your heart and lungs ["cardiopulmonary resuscitation" (CPR)] unless you execute a Do Not Resuscitate Directive ("DNR").

A DNR [(also known as "Do Not Attempt Resuscitation" (DNAR)] lets you express the wish that you do not want emergency treatment to restart your heart and lungs if your heartbeat or breathing stops. To put it bluntly, a DNR means you do not want to be brought back from the dead. A DNR order does not and should not affect any other treatment decisions. For instance, a person with a DNR order can be put on a respirator if he or she just has difficulty breathing. This is not the same as a person who has stopped breathing.

There are two kinds of DNR:

  • A DNR order in a hospital chart. This DNR is used in hospitals. It is permitted in all states
  • A non-hospital DNR which is permitted in many states. The latter document is known as a Out-of-Hospital DNR form. It keeps unwanted CPR or intubations from occurring in your home or during transport to or from a hospital.

There are steps to take to be sure your wishes are complied with, including posting a copy of the DNR where it will be seen in case of an emergency. For non-hospital events, the question of whether a DNR is legal or whether emergency responders will comply with it can be avoided by letting all caretakers know that if you stop breathing, not to call 911 until it is too late to admnister CPR.

For practical purposes, assume that your DNR has to by signed by a doctor as well as by yourself.

We recommend that people who complete a DNR execute a new one each time you enter a health care facility or change health care providers. Using  the facility's or provider's form will save time during an emergency. It avoids their having to take the time to decide whether your DNR meets the guidelines they set for a DNR directive.

Neither a Living Will or a Health Care Power Of Attorney substitutes for a DNR. They will not be honored in the subject situation.

NOTE: All too frequently a DNR is not honored because medical personnel in Intensive Care Units (ICUs) are not aware they exist or are too busy to read them. If you appoint a person to act as your health care Proxy, he or she can be sure medical personnel are alerted to your DNR wishes - and help enforce them. (To learn about the documents which appoint a health care Proxy, click here.) If you want to be absolutely certain that your DNR wishes are honored, tatoo or write with indelible ink the letters DNR on your chest.

For more information, see:

What Is A DNR Directive?

A Do Not Resuscitate (DNR) Directive is an Advance Directive that puts in writing your wish that nothing be done to revive you if your heart or lungs stop working. The medical profession calls these events "cardiac arrest" and "respiratory failure" respectively.

A DNR Directive has nothing to do with the question of whether to shut off machines such as ventilators or dialysis machines or to stop nutrients or fluids. For documents concerning those subjects, see Living Will and Healthcare Power of Attorney.

There are two types of DNR directive:

  • For use in a medical facility (in-hospital) - which is permitted in all states
  • For use outside a hospital setting (non-hospital) - which is permitted in a large number of states, but not all.

An in hospital DNR will not be honored by emergency personnel outside of a medical facility setting.

A DNR is primarily used by people who are approaching the end of their life. It is particularly useful to people who know that if they are revived, they will face a quality of life they don't want.

Unlike a Living Will or a Healthcare Power Of Attorney, in most states, a DNR has to be signed by both the patient and the attending doctor.

A DNR can be rescinded at any time.

Non-hospital DNR

Unless a state specifically permits non-hospital DNRs, Emergency Medical Services (EMS) personnel are obligated  to administer CPR and to do what they can to maintain life - even if there is a Living Will or a person acting as health care proxy who tries to stop it..

Approximately half the states have enacted laws that give validity to non-hospital DNRs that will be recognized and respected by EMS personnel. The states generally require a special document. In some states a bracelet must be worn.

The states that have enacted legislation authorizing the use of these "pre hospital" or "non hospital" DNR documents are:  Alabama, Alaska, , Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Kansas, Maryland, Michigan, Montana, Nevada, New York, Oklahoma, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.

To check the law in your state, offsite link has a listing of state laws. Look under "Health". Since laws relating to these documents (advance directive laws) may be in different portions of a state's codes, also look under Public Health, Probate, as well as Health and Safety. Alternatively, local Medicaid offices are required to maintain written descriptions of the state's laws regarding DNRs and other Advance Directives. You can find the location of the nearest Medicaid office via offsite link or in the Government pages of your telephone directory.

Of course you can always contact an attorney. (To learn how to find a free or low cost attorney, click here.)

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Choosing An Attorney

Should I Execute A DNR?

There is no right or wrong. Whether to execute a DNR is solely up to you.

Consider the following:

  • That realistically, a DNR only applies when the question is whether to bring you back after you've stopped breathing or your heart has stopped beating.
  • A DNR does not leave room for someone to make a choice considering the overall situation. It is black and white: if your heart or lungs fail, a DNR orders people not to revive you. DNRs do not cover the situation, for example, of telling medical personnel: "If it appears the patient will recover and have a good life, then revive - but if that's not the case, don't."
  • How does the idea of a DNR fit within your religious, cultural and philosophical beliefs?
  • What are your current circumstances?
    • If you are entering a hospital, is it for a procedure or test so that you fully expect to leave the facility and resume your life?
    • Is your quality of life unbearable and not likely to improve?
    • Are you in a situation that is likely to be terminal within a short period of time? Are you ready to stop fighting and let go?

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Related Articles

Hospice Care End Of Life

Why Do I Need A DNR Directive If I Already Have A Living Will And A Healthcare Power Of Attorney?

Living Wills and Health Care Powers of Attorney are not designed for the administration of CPR. In fact, in some states, these documents are not permitted to control CPR

Living Wills and Healthcare Proxies are designed to permit medical decisions to be made when you are unable to make them and when there is time to determine your wishes, assess your health condition, make predictions about what will happen, and then make a decision. However, when your heart or lungs stop, there is no time to call people, sift through documents or assess the overall situation. Your wishes must be made known immediately. A DNR Directive accomplishes that.

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What If I Want To Be Resuscitated?

If you want your caregivers to do everything possible to keep you alive including restoring pulse and breathing, simply do not complete a DNR Directive. Without a DNR, the medical professionals are obligated to use all means possible to restore your pulse and breathing.

If you do have an active DNR order, you may rescind it at any time, either by destroying or marking the DNR order “VOID”, or by telling medical personnel at the time of crisis to ignore the order and resuscitate you.

Where Do I Find The Appropriate Forms For A DNR?

If you are in or going to be in a health care facility or you are being cared for by a home health agency

The best source from which to obtain a DNR Directive is the healthcare facility or the home health agency that is providing your care. Each facility has a form that is appropriate for the state in which you are located.

  • Execute a new DNR each time you enter a health care facility or change health care providers. Since DNR Directives all provide the same instructions, there is no conflict if you have more than one DNR Directive in your records.
  • Use the form of the facility or provider. This will avoid the medical facility or agency having to take the time to decide whether your DNR meets the guidelines they set for a DNR directive either before or during an emergency.

If you are not in a health care facility

If you live in a state which permits a Non-hospital DNR, your doctor (or home health agency if you have one) will be able to provide the appropriate forms. You can also find them at offsite linkclick on "What We Do", then "Your important documents" then "Advance Directive By State, or call Tel.: 800.247.7421

Information about DNR documents and how to get them

For information about the documents in your state and how to get them, see offsite link. Click on "Out-of-hospital-DNR Information"

How To Enforce A DNR

To enforce a DNR directive:

  • Follow the law of your state when executing the DNR.
  • Confirm with your attending doctor that he or she is willing to comply with your DNR directive. 
    • If the answer is no, consider finding another doctor who will honor your wishes. 
    • In some states, if the doctor says no, he or she is obligated to help you find another doctor.
  • Put mechanisms in place so medical personnel who respond to a cardiopulmonary call will know not to administer CPR. For example, post a sign over your bed that says "DNR." 
  • If you are at home or in another non-medical setting, a practical method of enforcing a DNR is to instruct caregivers not to call emergency personnel if you stop breathing.
  • An extreme approach is to tattoo "DNR" on your chest.

In hospital

  • Execute a DNR using the hospital's form. It avoids questions whether the document is valid.
  • Be sure the DNR is included in your chart in a conspicuous manner.
  • Let each of your nurses know that you have signed a DNR and wish it to be honored. If you don't want to repeat yourself, ask a friend or other patient advocate to do it for you.
  • Put a sign on the wall above your bed stating that a DNR is in effect.

If you are getting care at home or are in another non-hospital setting

  • If you use a health care agency or hospice, execute your DNR using their form. If you change agencies or hospices, execute the new entity's form.
  • Keep a copy of the DNR handy. Let each caretaker know about your wishes and where the DNR is located.
  • Let each of your caretakers know your wishes. Consider asking that they not call 911. If 911 is inadvertently called, all other people who could be on the premises should know where the DNR is.
  • Post a notice that you have a DNR above your bed or in an area that emergency people will have to pass through in their way to you.