Do not resuscitate

From Wikipedia, the free encyclopedia

The examples and perspective in this article or section may not represent a worldwide view of the subject.
Please improve this article or discuss the issue on the talk page.

A DNR/DNI, or Do Not Resuscitate/Do Not Intubate order, is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. This is sometimes known as a no-code order. Such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy; in some jurisdictions, such orders can also be instituted on the basis of a physician's own initiative, usually when resuscitation would not alter the ultimate outcome of a disease.

Any person who does not wish to undergo lifesaving treatment in the event of cardiac or respiratory arrest can get a DNR order, although DNR is more commonly done when a person who has an inevitably fatal illness wishes to have a more natural death without painful or invasive medical procedures.

The DNR order came into being in the U.S. in the 1960s when defibrillation allowed the reversal of cardiac arrest, but this may prolong the life of the patient for only a short time.

In the U.S., cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) should not be performed if a valid written "DNR" order is present. In any cases of doubt, emergency medical technicians, paramedics and other medical workers will perform as if a DNR order did not exist, as is required by law.

For the DNR to be valid there may be rules such as the use of a special form and/or additional signatures of a doctor and/or witnesses, etc. The exact rules for obtaining and for emergency medical personnel accepting the validity of a DNR order vary widely according to jurisdiction. For example, in the state of Maryland, only Maryland-state DNR orders are acceptable, and they require much verification, witnesses and doctor's signatures in order to be valid. In contrast, the state of West Virginia allows patients to receive a DNR order with relative ease, and will accept them from most other jurisdictions.

In many jurisdictions, medical professionals are ordered not to acknowledge DNR orders. This is especially common with paramedics, who are often employed by private companies unwilling to fight a potential lawsuit.

A DNR order must be filed on a jurisdictionally-recognized form. A doctor contemplating a DNR decision should make every reasonable effort to confirm a DNR status before deciding to withhold resuscitation. To be sure that their DNR request is honored, patients should make their wishes clearly known to their family, doctors, community hospitals, care homes and any other caregivers or health care providers who may be present should a cardiac arrest occur. Some jurisdictions provide for a legally sanctioned-DNR notification that is clearly visible to all healthcare personnel, similar to a MedicAlert bracelet.

A DNR order's specific effect depends on the hospital in which the incident occurs and the terms laid out in the DNR: neither cardiopulmonary resuscitation nor intubation will be performed, but treatment for infections or other treatable conditions, intravenous feeding and fluids, pain management and comfort care are generally continued.

In Australia and New Zealand, the term NFR (Not For Resuscitation) is used.