What Is a Do Not Resuscitate Order and Why It Matters
A Do Not Resuscitate order, commonly called a DNR, is a legal document that tells medical professionals not to perform cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. When someone's heart stops or they stop breathing, medical teams are trained to immediately start CPR—chest compressions and rescue breaths—to try to restart the heart. A DNR order changes this automatic response by instructing doctors and nurses to let natural death occur without attempting these life-saving measures.
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According to the American Heart Association, approximately 475,000 cardiac arrests occur outside of hospitals in the United States each year. Of those, only about 12% of people survive. For people with serious illnesses, advanced age, or specific medical conditions, CPR may not restore quality of life or may cause additional suffering. This is why understanding DNR orders matters—they reflect personal values about medical treatment at the end of life.
It's important to understand what a DNR does and does not do. A DNR order prevents only CPR and related emergency measures like intubation (placing a breathing tube). It does not prevent other medical care. Doctors will still provide comfort medications, oxygen, antibiotics, fluids, and other treatments to keep you comfortable. A DNR is specifically about what happens in the moment when the heart stops or breathing stops.
Many people misunderstand DNR orders, thinking they mean "do not treat" or "do not hospitalize." This is not accurate. A person with a DNR can still receive hospital care, surgery, physical therapy, pain management, and other medical interventions. The order only addresses the specific situation of cardiac or respiratory arrest.
Practical takeaway: A DNR order is a choice about one specific medical intervention—CPR—in the event of cardiac or respiratory failure. Understanding this distinction helps people and families make informed decisions about end-of-life care.
Who Should Consider a DNR Order
DNR orders are most commonly discussed with people facing serious health conditions, advanced age, or terminal illness. However, anyone over the age of 18 can legally have a DNR order if they choose. The decision to pursue a DNR is deeply personal and depends on individual values, medical situation, and life circumstances.
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People with advanced cancer, heart disease, chronic lung disease, dementia, or other serious conditions often have conversations with their doctors about DNR orders. Studies show that 70-80% of people say they would not want CPR if it meant surviving in a state of severe disability or dependence on machines. For these individuals, a DNR order may align with their values and preferences.
Older adults frequently consider DNR orders. According to data from the CDC, about one-third of Medicare beneficiaries (people 65 and older) have a DNR order in place. This reflects the reality that as people age and develop chronic conditions, survival rates from CPR decline. A 90-year-old person who receives CPR has less than a 5% chance of surviving to discharge from the hospital, and those who do survive often experience broken ribs, organ damage, and prolonged hospitalization.
People with specific conditions may want to discuss DNR orders with their doctors: advanced dementia where the person no longer recognizes family or can communicate; advanced heart failure where the heart is severely weakened; end-stage kidney disease requiring dialysis; severe chronic obstructive pulmonary disease (COPD); or metastatic cancer that has spread throughout the body and is no longer responding to treatment.
Importantly, a person doesn't need to be terminally ill to have a DNR. Some people choose DNR orders because they value quality of life over quantity and prefer to focus on comfort care rather than aggressive interventions. Others may have religious or philosophical beliefs that inform this choice.
Practical takeaway: Consider discussing DNR options with a doctor if you have a serious health condition, are over 65, or have thought about your end-of-life preferences. The conversation can happen at any time and can be changed if your wishes change.
The Medical Reality of CPR and Survival Rates
To make an informed decision about DNR orders, it helps to understand what CPR actually accomplishes and what the chances of survival look like. CPR involves rapid chest compressions—pushing hard and fast on the chest—combined with rescue breaths to try to restart the heart and get oxygen to the brain. When performed immediately by trained people, CPR can be effective, particularly for people who collapse from a sudden heart attack with no other underlying diseases.
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The outcomes of CPR vary dramatically depending on circumstances. When CPR is performed within minutes of collapse by bystanders or emergency medical technicians (EMTs), and the person has a witnessed, sudden cardiac arrest with a specific heart rhythm problem, survival rates can be 30-70% according to the American Heart Association. These are the best-case scenarios, often involving younger, healthier people with no other serious illnesses.
However, outcomes are very different for hospitalized patients or those with serious underlying conditions. For people hospitalized in the intensive care unit (ICU) who receive CPR, only about 15-20% survive to leave the hospital. For people outside the hospital with terminal illnesses, the survival rate can be as low as 1-5%. A study published in JAMA Internal Medicine reviewed CPR outcomes in nursing homes and found that only 1% of residents who received CPR survived to discharge, and those who did had significant disabilities.
When CPR is successful in restarting the heart, the person may still face complications. CPR can cause broken ribs, internal bleeding, punctured lungs, and brain damage from lack of oxygen. Some people recover fully. Others survive but with permanent cognitive impairment, requiring long-term care in nursing facilities. Still others survive briefly but die within days or weeks from their underlying illness.
Age and health status matter significantly. A healthy 50-year-old who collapses from a sudden heart attack has a much better prognosis than an 85-year-old with advanced dementia, heart disease, kidney failure, and cancer. Doctors can discuss these realities and what CPR might or might not accomplish in a specific person's medical situation.
Practical takeaway: Before deciding about a DNR order, learn what CPR success looks like in your particular health situation. Ask your doctor: "If I had CPR performed, what is the realistic chance it would help me, and what might I face afterward?" This conversation grounds the decision in medical reality rather than assumptions.
How to Create or Update a DNR Order
Creating a DNR order involves several steps, and the process varies slightly depending on where you live. In most U.S. states, a DNR is a legal document that must be signed and witnessed. Some states allow it to be part of a broader advance directive or living will, while others have a specific DNR form.
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The first step is to have a conversation with your doctor. You can start this discussion by saying something like, "I'd like to talk about what medical interventions I would or wouldn't want if my heart stops or I stop breathing." Your doctor should discuss your health condition, prognosis, and what CPR might realistically accomplish. This conversation helps clarify your values and ensures the DNR reflects your actual wishes, not assumptions or fears.
Once you've decided a DNR is right for you, your doctor can provide the DNR form used in your state. Many states have official forms that must be used for the DNR to be legal and recognized by emergency personnel. You can also obtain forms through your hospital, your state's health department website, or organizations like The Conversation Project or Five Wishes, which offer free templates and guides.
The DNR document typically requires your signature and the signature of two witnesses who are not related to you and not your healthcare provider. Some states require a notary public to verify your signature. You should keep the original signed document in an easily accessible place—not in a safe deposit box where it might not be found in an emergency. Copies should go to your doctor, your hospital if you're a patient there, and your family members.
In most states, you can create a DNR order at any time, and you can change it or cancel it at any time. If you've had a DNR in place but your situation has changed and you now want CPR performed, you can simply destroy the document or tell your medical team you want it revoked. Some states allow verbal revocation of a DNR, but it's best to notify your doctor in writing and request an updated chart note.