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When it comes to planning for medical care during critical moments, a Do Not Resuscitate Order (DNR) serves as a pivotal legal document. This form communicates a patient's wish not to undergo CPR (cardiopulmonary resuscitation) in the event their heart stops or they stop breathing. Designed to respect the patient's healthcare preferences, this order must be signed by both the patient and their healthcare provider to be considered valid. Importantly, it reflects a decision made after careful consideration of the patient's health status, values, and beliefs about end-of-life care. Moreover, the form plays a crucial role within healthcare settings, guiding healthcare professionals in honoring the patient's wishes without the need for immediate family consent during emergencies. As such, it is paramount for individuals, especially those with chronic conditions or in palliative care, to understand how to properly discuss and complete a DNR form. This ensures that their healthcare preferences are clearly communicated and legally documented, thereby providing peace of mind to both the patient and their loved ones.

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This Do Not Resuscitate Order (DNR) is a directive for medical professionals and family members regarding the refusal of cardiopulmonary resuscitation (CPR) in the event that a patient's breathing ceases or their heart stops beating. This document is designed to respect the patient's wishes concerning end-of-life care. It is applicable in the context of the laws governing the state in which it is executed. Please consult state-specific regulations for further details.

Personal Information:

  1. Full Name: ___________________________________________________
  2. Date of Birth: ________________________ (MM/DD/YYYY)
  3. Address: ______________________________________________________
  4. City: ____________________ State: __________ Zip Code: _________
  5. Phone Number: ________________________________________________

State-Specific Directive:

This DNR order is subject to the laws and requirements of the State of __________. By executing this document, the undersigned acknowledges the specific regulations and procedures defined by said state, including any statutory forms or certification required.

Directive Statement:

I, ___________________________________ [Full Name], being of sound mind, direct that in the event my heart stops beating or I stop breathing, no medical procedure to restart breathing or heart functioning shall be instituted. I understand that this decision will not prevent me from receiving other medical treatments such as pain relief, nutrition, and hydration if I desire. This decision is made after careful consideration, and it reflects my values and wishes regarding quality of life and the nature of dying.

Witness Declaration:

I hereby certify that the individual signing this document has expressed their wishes to me and appears to be of sound mind and not under duress, fraud, or undue influence. I affirm that my relationship to the declarant does not render me ineligible to act as a witness under the applicable state laws.

Witness 1 Full Name: _________________________________________

Witness 2 Full Name: _________________________________________

Signature of Witness 1: ________________________________________ Date: ________________

Signature of Witness 2: ________________________________________ Date: ________________

Signature:

I understand the full import of this directive and affirm that executing this DNR order is my legal right and is made according to my desires regarding my medical treatment. I am aware that I can revoke this order at any time.

Signature of Declarant: _______________________________________ Date: ________________

Physician Acknowledgment:

This document has been discussed with the declarant, and I am satisfied that the patient/declarant understands the nature, import, and implications of their decision.

Physician's Name: _____________________________________________

Signature of Physician: ________________________________________ Date: ________________

License Number: ______________________________________________

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Document Specs

Fact Number Description
1 A Do Not Resuscitate Order (DNR) instructs medical personnel not to perform CPR if a patient's breathing stops or if the patient's heart stops beating.
2 A DNR order is created by a patient or the patient's healthcare proxy, in consultation with a healthcare provider.
3 DNR orders are recognized and can be implemented in all healthcare settings, including hospitals, nursing homes, and in the home.
4 The specific regulations and forms for DNR orders vary by state, reflecting differences in state laws.
5 In some states, DNR orders are also known as "Allow Natural Death" (AND) orders, emphasizing the focus on comfort and quality of life.
6 To be valid, a DNR order must usually be signed by both the patient (or their legally authorized representative) and the patient's physician.
7 In many cases, the existence of a DNR order needs to be clearly communicated to all healthcare providers involved in the patient's care, often through wearing specific bracelets or necklaces.
8 DNR orders can typically be revoked by the patient or their healthcare proxy at any time, indicating a change in their healthcare preferences.
9 It is essential for individuals with a DNR order to discuss their wishes with family members and healthcare agents to prevent any confusion during an emergency.
10 While DNR orders focus on not initiating CPR, they do not impact other forms of medical treatment unless specifically stated as part of a broader advance directive.

Steps to Writing Do Not Resuscitate Order

After deciding that a Do Not Resuscitate (DNR) order aligns with the wishes and healthcare goals of either yourself or someone you're making decisions for, the next step is to properly fill out the required form. This process ensures that the healthcare team knows not to perform CPR (cardiopulmonary resuscitation) in the event of a cardiac or respiratory arrest. It’s a critical step that communicates specific medical wishes clearly and concisely. Here’s a straightforward guide to completing the form correctly.

  1. Identify the patient: Start by clearly printing the full name of the person the DNR order is for. This ensures there's no confusion about whose wishes are being represented.
  2. Include patient identification information: Fill in the patient’s date of birth, social security number (if applicable), and address. This information helps further ensure the DNR order is correctly attributed.
  3. Document the medical condition: While not all forms require this, some ask for a brief description of the medical condition leading to the need for a DNR order. Keep the explanation clear and concise.
  4. Physician’s information: Enter the name, address, and phone number of the attending physician. This doctor will be the point of contact for any questions regarding the DNR order.
  5. Signature section: The form must be signed by the patient or the patient’s legally authorized representative if the patient is unable to do so. This section may also require a witness signature, so be sure to read the instructions carefully.
  6. Physician’s signature: For the DNR order to be valid, the attending physician must also sign and date the form, indicating their agreement and understanding of the patient’s wishes.
  7. Emergency contact information: Providing the name and phone number of an emergency contact is crucial. This person may be contacted for further information or in case of an emergency.
  8. Distribution: Once completed and signed, make copies of the DNR order. Keep the original with the patient’s important papers, give a copy to the primary physician, and have one available to present to emergency personnel if needed.

Once the form is filled out and all necessary signatures are in place, the DNR order becomes part of the patient’s medical record. It's a significant step that ensures a patient's wishes regarding CPR are respected. Moving forward, it's important to review and update the DNR order as necessary to make sure it still reflects the patient's current wishes and medical conditions.

Important Details about Do Not Resuscitate Order

What is a Do Not Resuscitate Order?

A Do Not Resuscitate Order (DNR) is a legal document that instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. The DNR is created based on an individual's wish to decline resuscitation in these critical situations. This decision is deeply personal and usually made after thoughtful discussions with healthcare providers, family members, or legal representatives about the person's health status and personal values.

How does one create a Do Not Resuscitate Order?

Creating a Do Not Resuscitate Order involves several important steps. First, it requires a conversation with a healthcare provider to thoroughly understand the implications of a DNR and to ensure it aligns with the patient's health care goals and values. Once a decision has been made, the healthcare provider will document the DNR in the patient's medical record. In many states, a specific form must be filled out and signed by both the healthcare provider and the patient or the patient's legally authorized representative. It's crucial to follow the regulations specific to one's state, as the requirements can vary.

Who can consent to a Do Not Resuscitate Order?

Consent to a Do Not Resuscitate Order can typically be given by the individual for whom the order is intended, provided they are of sound mind and can make informed decisions about their health. In cases where the individual is unable to make or communicate decisions, a legally authorized representative, such as a durable power of attorney for healthcare, may consent on the individual's behalf. This process ensures that the patient's rights and wishes are respected, even if they are not in a position to articulate them directly.

Where is a Do Not Resuscitate Order applicable?

A Do Not Resuscitate Order is applicable in a variety of settings, including hospitals, nursing homes, and in the individual's own home. It is crucial to inform all healthcare providers across these settings of the existence of a DNR to ensure its instructions are followed consistently. Additionally, individuals may carry a DNR form or wear a DNR bracelet to alert emergency personnel to their wishes in situations outside of a healthcare facility.

Can a Do Not Resuscitate Order be revoked?

Yes, a Do Not Resuscitate Order can be revoked at any time by the person for whom it was created, assuming they have the capacity to make that decision. To revoke a DNR, the individual or their legally authorized representative must inform the healthcare provider, and the revocation will be documented in the patient's medical record. In some cases, physically destroying the DNR document and its copies is also recommended to prevent confusion or misinterpretation.

How does a Do Not Resuscitate Order affect the quality of care?

A Do Not Resuscitate Order does not affect the quality of care provided to an individual beyond the specific instructions to forgo CPR. Healthcare providers continue to offer all other appropriate treatments and supportive care to improve the person's quality of life. The existence of a DNR order is purely to honor the individual's wishes regarding resuscitation efforts, ensuring that the care aligns with their values and desires for end-of-life care.

Common mistakes

One common mistake people make when filling out a Do Not Resuscitate (DNR) order form is not ensuring it's signed by both the patient and the authorized healthcare provider. The validity of a DNR order hinges on these signatures since they confirm that both parties have discussed and agreed on the decision not to pursue resuscitation in the event of cardiac or respiratory arrest. A missing signature could lead to unnecessary confusion or emergency interventions that go against the patient's wishes.

Another mistake often encountered is failing to discuss the DNR order with family members or loved ones. This crucial step ensures that those close to the patient understand the decision and the reasons behind it, which can prevent distressing disputes or disagreements when the order needs to be enacted. It's essential that family members are on the same page to support the patient's wishes during critical moments.

Some individuals neglect to review and update their DNR order. Over time, a person's health status or personal wishes regarding end-of-life care may change. If a DNR order is not regularly reviewed and updated to reflect current wishes, it might lead to the implementation of an outdated plan that no longer aligns with the patient's desires.

There is also the mistake of not making the DNR order accessible. In an emergency, healthcare providers need immediate access to the DNR order to follow the stipulated instructions. When the document is not easily accessible, emergency responders might perform resuscitation efforts against the patient's wishes. Therefore, it's vital to keep the DNR order in a prominent, known location and consider registering it with a medical alert system or electronic registry if available in your state.

Lastly, a significant error is not fully understanding the implications of a DNR order. Some individuals might not fully grasp that a DNR order specifically relates to cardiopulmonary resuscitation (CPR) and does not affect other forms of medical intervention. It's important for patients and their families to have a clear understanding of what a DNR order does and does not do, ensuring that the patient's wishes regarding other treatments and interventions are documented and communicated effectively.

Documents used along the form

Completing a Do Not Resuscitate (DNR) Order is a significant action that reflects a person's healthcare preferences, especially regarding end-of-life care. However, the DNR is just one component of a comprehensive approach to planning. There are several other forms and documents that individuals often use alongside a DNR to ensure their wishes are fully understood and respected. Here's a rundown of some key documents that often accompany a DNR.

  • Advance Directive - This legal document outlines a person’s preferences for future medical care if they become unable to communicate those wishes themselves. It can include decisions about the use of life-sustaining treatments, apart from resuscitation.
  • Medical Power of Attorney - Also known as a Healthcare Proxy, this document designates someone to make healthcare decisions on behalf of the individual, should they become incapacitated. It's crucial for ensuring decisions are made according to the person's values and desires.
  • Living Will - A type of Advance Directive, a Living Will specifies an individual's wishes regarding medical treatments and procedures they do or do not want in case they are unable to make their own decisions. It becomes active only under certain medical conditions.
  • POLST Form (Physician Orders for Life-Sustaining Treatment) - Similar to a DNR but more comprehensive, a POLST outlines a wide range of treatments an individual desires or refuses at the end of life and is designed to transfer across different care settings.
  • Will - A legal document that spells out how a person’s property and assets should be distributed after their death. While not a healthcare directive, it is a critical piece of any comprehensive end-of-life plan to ensure personal wishes are honored.
  • Organ and Tissue Donation Registration - A form used to record an individual's decision to donate their organs and tissues after death. Making one's wishes known in advance can be a gift of life for others and a comfort to the family.

In combination with a DNR Order, these documents help create a clear, legally sound framework for end-of-life decision-making. Handling these matters well ahead of time can significantly ease the burden on individuals and their families during challenging moments, ensuring that healthcare preferences are honored in the most respectful way possible.

Similar forms

The Do Not Resuscitate (DNR) Order form bears similarity to a Living Will, as both documents guide healthcare professionals on a patient's preferences for medical treatment at the end of life. While a DNR specifically directs medical teams not to perform CPR or other life-saving measures if a patient's breathing or heartbeat stops, a Living Will covers a broader range of medical interventions a patient may or may not want, based on various medical scenarios. Each serves as a critical tool in ensuring that a patient's healthcare wishes are followed when they cannot communicate their desires due to medical incapacitation.

Comparable to a DNR is a Medical Power of Attorney (POA), which authorizes another individual to make healthcare decisions on someone's behalf if they become incapable of doing so. The scope of a Medical POA can be broad, entrusting the appointed individual with decisions about accepting or refusing any medical treatment, including measures to prolong life. Unlike the specific instructions provided in a DNR, the decision-making authority in a Medical POA encompasses a wide range of medical scenarios, not limited to resuscitation efforts.

The Physician Orders for Life-Sustaining Treatment (POLST) form is another document closely related to a DNR, designed for seriously ill patients to outline their preferences for end-of-life care, including their wishes regarding CPR. What differentiates POLST from a DNR is its inclusivity of instructions for other life-sustaining treatments, such as mechanical ventilation or feeding tubes, making it a more comprehensive directive for healthcare providers.

An Advance Healthcare Directive, like a DNR, is a legal document that specifies a person's healthcare preferences, including the refusal of or consent to certain treatments. An Advance Directive can encompass a Living Will and a Medical POA, providing a detailed roadmap of an individual's desires for their medical care, to which health professionals must adhere. This document ensures that a person's healthcare choices are respected, much like a DNR's specific directive regarding resuscitation.

Similarly, a Healthcare Proxy designates an individual to make medical decisions on another’s behalf, akin to a Medical POA. The distinction lies mainly in terminology and slight variations in applicability depending on the state's laws. Just like a DNR allows a patient to assert control over the decision not to undergo CPR, a Healthcare Proxy enables a patient to ensure their broader health care decisions can be made by someone they trust, in case they are unable to express their wishes.

The Five Wishes document merges aspects of several of the previously mentioned documents, offering a comprehensive approach to documenting one's preferences for end-of-life care, including personal, spiritual, and medical desires. It goes beyond the scope of a DNR by addressing the individual’s wishes concerning their comfort, how they want to be treated, what they want their loved ones to know, and more. While a DNR focuses strictly on the absence of resuscitation efforts, the Five Wishes document provides a platform for a broader conversation about end-of-life care.

Lastly, a Durable Power of Attorney for Health Care bears resemblance to both a Medical POA and a Healthcare Proxy by enabling a designated proxy to make healthcare decisions on behalf of the incapacitated individual. It stands out by remaining in effect only when the individual is deemed unable to make decisions for themselves. Similar to how a DNR represents a person's specific wishes regarding not being resuscitated, this document serves as a broader indicative of trust in someone's judgment for various medical decisions.

Dos and Don'ts

When completing a Do Not Resuscitate (DNR) Order form, individuals are encouraged to approach this process with the utmost care and awareness. To assist, here's a list of essential dos and don'ts:

Do:
  • Ensure accuracy: Confirm all personal information, including full name and date of birth, is accurately recorded on the form.
  • Consult healthcare professionals: Seek advice from healthcare providers to understand the implications fully and ensure it aligns with personal healthcare goals.
  • Use clear language: Make certain the instructions are stated clearly to avoid any potential confusion or misinterpretation.
  • Review state laws: Acknowledge that requirements can vary by state, and ensure the form meets local regulations and laws.
  • Sign and date: Remember, the form must be signed and dated to be considered valid.
Don't:
  • Leave sections incomplete: Do not skip any sections. Incomplete forms may not be honored by healthcare providers.
  • Rely on verbal instructions: Understand that oral directives might not be legally binding in some situations; completing the form is crucial.
  • Forget witness or notary requirements: If a witness or notary is required by state law, do not overlook this step.
  • Use ambiguous terms: Avoid using vague language that could lead to differing interpretations by medical personnel.
  • Delay sharing the form: Don't wait to share the completed form with relevant parties, including family members and healthcare providers.

Misconceptions

When it comes to the Do Not Resuscitate (DNR) Order form, many people have misconceptions. It's crucial to understand what a DNR is and what it is not. Here, we clear up some of the most common misunderstandings.

  • DNR orders mean no medical treatment. This is not true. A DNR specifically relates to not performing CPR (cardiopulmonary resuscitation) in the event of cardiac or respiratory arrest. Patients with a DNR order still receive medical treatment and care, just not resuscitation.

  • Only elderly patients can have a DNR. This is a misconception. Patients of any age can have a DNR based on their health conditions, personal wishes, or medical advice. The decision is personal and varies from one individual to another.

  • DNR orders are permanent and cannot be changed. DNR orders can be revoked or altered at any time by the patient or their legal representative. It's a flexible document that can adapt to changes in the patient's condition or wishes.

  • A DNR order is applied across all medical settings. In reality, a DNR's applicability can vary. Some DNR orders are specific to a hospital setting, while others are valid in any setting, including at home. It depends on the type of DNR and the state laws governing it.

  • Doctors decide to issue DNR orders without patient consent. Ethically and legally, patients (or their legal representatives) must consent to a DNR order. It's a decision made after discussing the patient's wishes, health status, and understanding of the order's implications.

  • A DNR order affects the intensity of care a patient receives. This is incorrect. The level of care and compassion given to patients is not decreased by having a DNR order. The order solely affects the use of CPR in case of cardiac or respiratory failure.

  • Healthcare proxies cannot request a DNR order. If a patient is unable to make their own healthcare decisions, a legally-appointed healthcare proxy or power of attorney can request a DNR order on behalf of the patient, based on previously expressed wishes of the patient or what is believed to be in the best interest of the patient.

  • A DNR order means "Do Not Treat." This is a common misunderstanding. "Do Not Treat" is entirely different from a DNR order. A DNR specifically refers to not performing CPR, while "Do Not Treat" would imply no treatment for any medical condition, which is not the case with a DNR.

  • All family members must agree for a DNR to be issued. The agreement of all family members is not required to issue a DNR order. The decision is based on the patient's wishes or, if the patient is unable, the decision of a legally designated representative or healthcare proxy.

Key takeaways

If you're considering a Do Not Resuscitate (DNR) Order for yourself or someone you care for, understanding the key aspects of this form is crucial. A DNR order is a legal document that communicates a person's wish not to have cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing. Here are the top takeaways you need to know:

  • Only complete a DNR order after careful consideration and consultation with a healthcare professional. Understanding the implications for all scenarios is crucial.
  • DNR orders must be signed by a licensed physician to be valid. The signature confirms that the physician has discussed the decision's significance with the patient or their legal healthcare decision-maker.
  • Always ensure the DNR order is easily accessible and visible to emergency personnel, perhaps on the refrigerator or near the bed.
  • DNR orders can be revoked at any time by the patient or their duly authorized healthcare decision-maker. A verbal statement to rescind the order should be promptly followed by appropriate documentation.
  • In addition to the standard DNR order, consider wearing a DNR bracelet or necklace that emergency personnel can easily see in an emergency situation.
  • Each state may have its own specific form and requirements for DNR orders, so it's important to obtain and complete the form that is legally recognized in your state.
  • Discussing your wishes regarding a DNR order with family members and loved ones is important, so they understand your wishes and the reasoning behind them.
  • Remember, a DNR order does not affect other types of medical care. You or your loved one will still receive appropriate treatments to relieve pain and suffering or to address other health care needs.
  • DNR orders are part of a broader advance care planning process. Consider drafting other advance directives, such as a living will or healthcare power of attorney, to cover decisions not covered by a DNR order.
  • Certain circumstances, such as being admitted to a hospital, may require a review and possible re-issuance of the DNR order in accordance with hospital policy or state laws.

Properly understanding and documenting end-of-life wishes ensures that these wishes are respected. A DNR order is a critical component for those who decide that CPR is not the route they wish to take in the event of cardiac or respiratory arrest. By keeping these key takeaways in mind, individuals can make informed decisions that are right for them.

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