The decision to pursue a Do Not Resuscitate (DNR) card is a significant step in planning medical care. This guide explains the process, emphasizes state-specific nuances, and clarifies how DNR orders interact with other life-sustaining treatment documents. It also covers how to ensure a DNR order is honored in emergencies, by healthcare providers, and in long-term care settings.
Understand The Difference Between DNR, DNAR, And POLST
A DNR card is a medical order indicating that cardiopulmonary resuscitation (CPR) should not be performed if a patient’s heart stops beating or they stop breathing. Some regions use the term DNAR (do not attempt resuscitation) interchangeably. In many states, a related and often more flexible document is the POLST (Physician Order for Life-Sustaining Treatment) form, which translates patient preferences into actionable medical orders for healthcare professionals across settings.
Key distinction: DNR/DNAR is a hospital- or clinician-issued order focused specifically on resuscitation, while POLST covers broader life-sustaining choices, such as intubation, ventilation, and feeding tubes. The POLST often travels with the patient and is intended for use in all care environments, including home, hospice, and emergency services.
Assess Your Situation And Preferences
Before pursuing a DNR card, reflect on goals of care, quality of life, and personal values. Consider how treatment decisions align with the likely outcomes in different scenarios. Discuss with loved ones to ensure preferences are clearly understood and can be honored under stress or chaos during a medical crisis.
- Consider the likelihood of benefit from resuscitation in various conditions.
- Think about other preferences, such as halting aggressive interventions or opting for comfort-focused care.
- Identify a healthcare proxy or durable power of attorney for healthcare if desired.
Speak With A Licensed Healthcare Provider
Creating a DNR order requires a clinician’s assessment and professional judgment. Schedule a conversation with a physician, nurse practitioner, or physician assistant to discuss prognosis, treatment options, and whether a DNR order is appropriate. If a POLST is more suitable, ask about the available form and how it will be implemented across settings.
During the visit, bring any relevant medical information, including chronic conditions, advance directives from other documents, and any previously stated wishes. The clinician will ensure that the plan complies with state laws and facilities’ policies.
Choose The Right Form For Your State
State laws shape how DNR and POLST documents are created, stored, and honored. Some states use a stand-alone DNR order, while others emphasize POLST as the preferred tool for comprehensive treatment preferences. Forms vary in terminology, required signatures, and validity periods. It is essential to obtain the correct form for the patient’s state of residence and care setting.
Helpful steps:
- Ask the clinician for the exact form name used in your state (DNR, DNAR, POLST, or another designation).
- Ensure the form includes the patient’s full legal name, date of birth, and a clear resuscitation instruction (e.g., CPR blocked or not).
- Verify whether multiple copies are needed for hospital records, primary care documents, and portable emergency records.
Complete And Sign The Form Correctly
Accuracy is critical. The patient, and in some cases a legally authorized representative, must sign the document. Some states require witnessing or notarization. Instructions must be followed precisely to prevent delays or misinterpretation during an emergency.
If the patient lacks decision-making capacity, a legally authorized surrogate or guardian may consent to a DNR/POLST on their behalf, following state rules. The clinician will verify the surrogate’s authority and document the decision accordingly.
Keep The DNR Or POLST Easily Accessible
A DNR card or POLST should be readily accessible to emergency responders, hospitals, and caregivers. Carry a copy in wallets or purses, keep digital copies on secure devices, and ensure care facilities have access to the most current form. In facilities such as nursing homes or hospices, provide copies to front desk staff and the patient’s primary clinician.
Advise family members and the primary care team of where the form is stored and how to access it quickly in an urgent situation.
Review And Update Regularly
Health circumstances change over time; a DNR or POLST should be reviewed periodically and after major medical events, legal changes, or relocation to a new state or facility. Revisit preferences with a clinician to confirm continued alignment with current health status and personal wishes.
- Update after new diagnoses or prognosis changes.
- Inform all relevant parties when preferences change.
- Withdraw or modify orders if desired, following the same formal process.
Understand How DNR Orders Are Honored In Different Settings
Emergency medical services (EMS), hospitals, and long-term care facilities are required to honor valid DNR or POLST orders, but enforcement can vary by jurisdiction and setting. In some states, EMS will not honor an unsigned or invalid form. In others, a physician’s signature or a nurse’s confirmation is required. Always verify the exact requirements for the patient’s state and care environment.
Here are practical tips to improve consistency:
- Provide EMS with the latest form and copies during transport or visits to the ER.
- Keep forms in clearly labeled, readily identifiable places, such as a wallet card and medical records.
- Inform first responders and care teams about any additional instructions, such as comfort-focused care or use of antibiotics for infections when appropriate.
Special Considerations For Hospitals, Nursing Homes, And Home Care
Hospitals and long-term care facilities often have policies that guide the use of DNR and POLST forms. Ensure staff training and internal procedures align with patient wishes. For home care and hospice, communicate with the care team about comfort measures, medication plans, and any expected changes in health status.
In all settings, a DNR card or POLST does not mean a patient cannot receive other forms of medical care. It only specifies resuscitation preferences and, in the case of POLST, broader life-sustaining treatment decisions.
Key Resources To Help With The Process
Reliable information sources can guide decision-making and provide state-specific forms. Consider consulting:
- National POLST Paradigm for structured, patient-centered orders that travel with the patient.
- State Department of Health or equivalent agency for official DNR/DNAR and POLST forms and requirements.
- Primary care physicians, palliative care teams, and hospice programs for personalized guidance.
- Legal resources or patient advocacy organizations offering advance care planning assistance.
Frequently Asked Questions
How do I get a DNR card? The typical path is a discussion with a licensed clinician, choosing the appropriate form (DNR or POLST), completing the form accurately, signing with required witnesses, and distributing copies to care providers and loved ones.
Can a DNR card be revoked? Yes. A patient or authorized surrogate can revoke or modify a DNR or POLST at any time, following the state’s process for amendments and ensuring all relevant parties are informed.
Will a DNR card affect comfort-focused care? Not at all. A DNR order specifically addresses resuscitation; other comfort measures and treatments can still be provided according to the patient’s wishes and medical advice.
Final Considerations
Obtaining a DNR card is a meaningful part of medical planning that emphasizes patient autonomy and clarity for caregivers. By understanding state-specific requirements, engaging with qualified clinicians, and ensuring accessibility of the document, individuals can ensure their wishes are respected across care settings and emergencies.