Deciding about CPR:
Do-Not-Resuscitate (DNR) Orders
A Guide for Patients and Families
Courtesy of NYS Department of Health
WHAT DO CPR AND DNR ORDERS MEAN ?
CPR - cardiopulmonary resuscitation - refers to the medical
procedures used to restart a patient's heart and breathing
when the patient suffers heart failure. CPR may involve
simple efforts such as mouth-to-mouth resuscitation and
external chest compression. Advanced CPR may involve
electric shock, insertion of a tube to open the patient's
airway, injection of medication into the heart and in extreme
cases, open chest heart massage.
A do-not-resuscitate (DNR) order tells medical professionals
not to perform CPR. This means that doctors, nurses and
emergency medical personnel will not attempt emergency CPR if
the patient's breathing or heartbeat stops.
DNR orders may be written for patients in a hospital or
nursing home, or for patients at home. Hospital DNR orders
tell the medical staff not to revive the patient if cardiac
arrest occurs. If the patient is in a nursing home or at
home, a DNR order tells the staff and emergency medical
personnel not to perform emergency resuscitation and not to
transfer the patient to a hospital for CPR.
WHY ARE DNR ORDERS ISSUED ?
CPR, when successful, restores heartbeat and breathing and
allows patients to resume their previous lifestyle. The
success of CPR depends on the patient's overall medical
condition. Age alone does not determine whether CPR will be
successful, although illnesses and frailties that go along
with age often make CPR less successful.
When patients are seriously ill or terminally ill, CPR may
not work or may only partially work, leaving the patient
brain-damaged or in a worse medical state than before the
heart stopped. In these cases, some patients prefer to be
cared for without aggressive efforts at resuscitation upon
CAN I REQUEST A DNR ORDER ?
Yes. All adult patients can request a DNR order. If you are
sick and unable to tell your doctor that you want a DNR order
written, a family member or close friend can decide for you.
IS MY RIGHT TO REQUEST OR RECEIVE OTHER TREATMENT AFFECTED BY A DNR
No. A DNR order is only a decision about CPR and does not
relate to any other treatment.
ARE DNR ORDERS ETHICALLY ACCEPTABLE ?
It is widely recognized by health care professionals, clergy,
lawyers and others that DNR orders are medically and
ethically appropriate under certain circumstances. For some
patients, CPR offers more burdens than benefits, and may be
against the patient's wishes.
IS MY CONSENT REQUIRED FOR A DNR ORDER ?
Your doctor must speak to you before entering a DNR order if
you are able to decide, unless your doctor believes that
discussing CPR with you would cause you severe harm. In an
emergency, it is assumed that all patients would consent to
CPR. However, if a doctor decides that CPR will not work, it
is not provided.
HOW CAN I MAKE MY WISHES ABOUT DNR KNOWN ?
An adult patient may consent to a DNR order orally by
informing a physician, or in writing, such as a living will,
if two witnesses are present. In addition, the Health Care
Proxy Law allows you to appoint someone you trust to make
decisions about CPR and other treatments if you become unable
to decide for yourself.
Before deciding about CPR, you should speak with your doctor
about your overall health and the benefits and burdens CPR
would provide for you. A full and early discussion between
you and your doctor will assure that your wishes will be
IF I REQUEST A DNR ORDER, MUST MY DOCTOR HONOR MY WISHES ?
If you don't want CPR and you request a DNR order, your
doctor must follow your wishes or:
- transfer your care to another doctor who will follow your
- begin a process to settle the dispute if you are in a
hospital or nursing home.
If the dispute is not resolved within 72 hours, your doctor
must enter the order or transfer you to the care of another
IF I AM NOT ABLE TO DECIDE ABOUT CPR FOR MYSELF, WHO WILL DECIDE ?
First, two doctors must determine that you are unable to
decide about CPR. You will be told of this determination and
have the right to object.
If you become unable to decide about CPR, and you did not
tell your doctor or others about your wishes in advance,
a DNR order can be written with the consent of someone chosen
by you, by a family member or by a close friend. The person
highest on the following list will decide about CPR for you:
- the person chosen by you to make health care decisions
under New York's Health Care Proxy Law;
- a court appointed guardian (if there is one);
- your closest relative (spouse, child, parent, sibling);
- close friend.
HOW CAN I SELECT SOMEONE TO DECIDE FOR ME ?
The Health Care Proxy Law allows adults to select someone
they trust to make all health care decisions for them when
they are no longer able to do so themselves, including
decisions about CPR. You can name someone by filling out a
health care proxy form, which you can get from your physician
or other health care professionals.
UNDER WHAT CIRCUMSTANCES CAN A FAMILY MEMBER OR CLOSE FRIEND DECIDE
THAT A DNR ORDER SHOULD BE WRITTEN ?
A family member or close friend can consent to a DNR order
only when you are unable to decide for yourself and you have
not appointed someone to decide for you. Your family member
Or friend can consent to a DNR order when:
- you are terminally ill; or
- you are permanently unconscious; or
- CPR will not work (would be medically futile); or
- CPR would impose an extraordinary burden on you given your
medical condition and the expected outcome of CPR.
Anyone deciding for you must base the decision on your
wishes, including your religious and moral beliefs, or if
your wishes are not known, on your best interests.
WHAT IF MEMBERS OF MY FAMILY DISAGREE ?
In a hospital or nursing home, your family can ask that the
disagreement be mediated. Your doctor can request mediation
if he or she is aware of any disagreement among your family
WHAT IF I LOSE THE ABILITY TO MAKE DECISIONS ABOUT CPR AND DO NOT
HAVE ANYONE WHO CAN DECIDE FOR ME ?
A DNR order can be written if two doctors decide that CPR
would not work or if a court approves of the DNR order.
It would be best if you discussed your wishes about CPR with
your doctor in advance.
WHO CAN CONSENT TO A DNR ORDER FOR CHILDREN ?
A DNR order can be entered for a child with the consent of
the child's parent or guardian. If the child is old enough
to understand and decide about CPR, the child's consent is
also required for a DNR order.
WHAT HAPPENS IF I CHANGE MY MIND AFTER A DNR ORDER HAS BEEN WRITTEN ?
You or anyone who consents to a DNR order for you can remove
the order by telling your doctor, nurses or others of the
WHAT HAPPENS TO A DNR ORDER IF I AM TRANSFERRED FROM A NURSING HOME
TO A HOSPITAL OR VICE VERSA ?
The DNR order will continue until a doctor examines you and
decides whether the order should remain or be canceled. If
the doctor decides to cancel the DNR order, you or anyone who
decided for you will be told and can ask that the DNR order
be entered again.
IF I AM AT HOME WITH A DNR ORDER, WHAT HAPPENS IF A FAMILY MEMBER OR
FRIEND PANICS AND CALLS AN AMBULANCE TO RESUSCITATE ME ?
If you have a DNR order and family members show it to
emergency personnel, they will not try to resuscitate you or
take you to a hospital emergency room for CPR.
WHAT HAPPENS TO MY DNR ORDER IF I AM TRANSFERRED FROM A HOSPITAL OR
NURSING HOME TO HOME CARE ?
The order issued for you in a hospital or nursing home will
not apply at home. You, your health care agent or family
member must specifically consent to a home DNR order. If you
leave a hospital or nursing home without a home DNR order, a
DNR order can be issued by a doctor for you at home.
[Hospitals must provide to patients a brochure developed by the
State Health Department that describes the Do-Not-Resuscitate law.
The brochure must be furnished to the patient at or prior to the
time of admission. It must also be furnished to each member of the
hospital's staff involved in the provision of medical care,and it
must be posted in a public place in each hospital.
Patient Self-Determination Act in OBRA '90 amending 1902 (a) (58) of
Social Security Act Public Health Law 2979]