DNR: What Does it Mean

What Does DNR Mean?

A consent to a Do Not Resuscitate order (DNR), whether in a hospital or nonhospital setting, is one type of advance instruction/directive that someone may give about his/her future medical treatment. Any adult may request a DNR order. However, patients and families should be encouraged to consult with their physician. Generally, although not always, DNR patients are victims of terminal illnesses and may be in skilled nursing facilities, private residences, or hospice settings.

A DNR order means specifically that IF cardiac and/or respiratory arrest occurs — that is, if a person stops breathing AND/OR his/her heart stops beating — THEN cardiopulmonary resuscitation (CPR) wil not be performed to revive the person. However, if the person is not in cardiac or respiratory arrest, appropriate medical treatment for all injuries, pain, difficult or insufficient breathing, hemorrhage and/or other medical conditions must be provided.

DNR Orders Outside the Hospital

A Nonhospital Order Not to Resuscitate means that at home, in the community, including an emergency room, or elsewhere outside a hospital, nursing home or certain mental health facilities, emergency medical services personnel will not perform CPR on the person for whom they have available proof that a valid DNR order exists. In the event a patient is admitted to a healthcare facility, the patient and the family should consult with their physician regarding updating the DNR orders.

This proof may either be the order itself, signed by the person's doctor, or the identification of a standard DNR bracelet on the patient.

Under state law, emergency medical services personnel who are presented with a valid DNR order, signed by a physician, or who identify a standard DNR bracelet on a person, must comply with that order. However, EMS personnel may still contact their medical control. Emergency medical personnel cannot withhold CPR unless they are sure that the patient has a valid DNR order.

How To Get an Out of Hospital DNR Order

Someone may ask his/her doctor to sign a New York State Department of Health Out of Hospital DNR (form DOH-3474). This form is available on the Department's website (www.nyhealth.gov/forms/doh-3474.pdf), or from the local DOH EMS office or health department. It is intended for patients not in a hospital or nursing home. The order may be issued to a person while still in a hopsital, to take effect after discharge, or it may be issued when the person is not hospitalized.

Who May Request a DNR Order on Behalf of Another

When a person is unable to decide about his/her own medical care and has appointed a health care agent under the health care proxy law, that appointee should decide about CPR and other treatments. When a person is sick and unable to ask the doctor about a DNR order and does not have a health care agent, a family member or close friend can decide about CPR for the patient under the following special circumstances. A family member or cose friend may consent to a DNR order only if two (2) physicians determine that the person is too ill to decide for him/herself and one of the following is true:

  • the patient is terminally ill with no hope of recovery;
  • the patient is permanently unconscious;
  • resuscitation would impose an extraordinary burden for the patient under his/her medical circumstances;
  • resuscitation would be medically futile.

The DNR Bracelet

This chain link bracelet has a stainless steel plate bearing the traditional medical symbol on the front and DO NOT RESUSCITATE in block letters on the back. Wearing the bracelet is completely voluntary but it alerts emergency medical services personnel that a valid nonhospital DNR order is in effect. A DNR bracelet may be purchased and worn only if a valid Nonhospital Order Not to Resuscitate, form DOH-3474, signed by the patient's doctor, has been issued. To request the form and information about where you may purchase a DNR bracelet, write to the:

New York State Department of Health
Box 2000
Albany, New York 12220.

To Withdraw a DNR Order

If the patient or anyone who consents to a DNR order on behalf of another changes his/her mind, the order can be removed by telling doctors, nurses or others about the decision. This need not be done in writing. Once informed of this decision, the patient's doctor must record the DNR revocation in the patient's chart, cancel the DNR order and make diligent efforts to retrieve all copies of the DNR form as well as the DNR bracelet.

Health Care Proxy

New York State's Health Care Proxy Law allows a person to appoint a trusted friend or family member to decide about medical treatment if one loses the ability to decide for him/herself. Request a free Health Care Proxy form on the Department website www.nyhealth.gov.

State of New York
Department of Health

Publication 4182; Revised 03/08