DNR orders — what they mean and how they work
This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.
The call came in the middle of the night. Your mother had collapsed at home. The paramedics arrived, and in those first moments of chaos and confusion, they made a choice. They started CPR. They pushed medications into her arm. They intubated her airway and rushed her to the hospital. Three days later, she woke up disoriented and in pain, hooked to machines she never wanted. The damage from those resuscitation efforts—the broken ribs, the complications that followed—might have been prevented if there had been a simple piece of paper on her refrigerator.
The conversation that leads to a Do Not Resuscitate order is one most families avoid. It asks you to imagine your parent in their worst moments, to talk about death before it's a crisis, to make explicit the things we usually leave vague. That's why so many people don't do it. That's also why so many people end up in situations they never wanted to be in.
A DNR order is not a death sentence. It's not giving up on your parent or letting them die. It's a statement about what kind of medical intervention makes sense for them at the end of life. It's about their right to refuse a specific treatment that might not be what they would choose. Understanding what it is, how it works, and how to get one in place matters more than you probably realize.
This is one of those legal documents that actually touches the most intimate parts of your parent's life and your relationship with them. That's what makes it important to understand clearly.
Understanding the Basics
A DNR order is a medical instruction. It tells paramedics and hospital staff that if your parent's heart stops beating or they stop breathing, they should not perform cardiopulmonary resuscitation. That's the whole thing. It's not a general instruction to not treat. It's not a do not treat anything order. It's specifically about CPR.
Here's why that distinction matters. When paramedics arrive at someone's home and there's no DNR order, they are legally required to attempt resuscitation on almost anyone. There are very few exceptions. A paramedic cannot check to see if someone would have wanted resuscitation. They cannot weigh whether the person is ninety-five years old or has terminal cancer. If there's no DNR order, they will start CPR. This is true even if your parent has expressed their wishes to you a hundred times. Your words are not a legal document.
CPR, by the way, is violent. Effective CPR often breaks ribs. It's uncomfortable even when it works. For someone who's frail, who has osteoporosis, who has metastatic cancer, who is dying from advanced dementia, the damage done by CPR might be worse than the condition it's trying to treat. The success rates change dramatically with age and underlying health. CPR might be exactly right for someone having a sudden heart attack at sixty. It might be causing harm for someone with advanced illness.
A DNR order changes what happens. It means paramedics will not attempt CPR. They will provide comfort care. They might provide oxygen or position your parent comfortably, but they will not do chest compressions or use defibrillators. In a hospital, a DNR order means the same thing, though hospitals usually have more detailed conversations about what other interventions your parent wants, like medications or oxygen.
The order needs to be in specific forms depending on where your parent lives. Different states have different names and requirements. Some call it a DNR order. Some call it a Do Not Resuscitate form. Some call it an out-of-hospital DNR. Some use the term DNRO or AND for Allow Natural Death. The substance is mostly the same, but the specific form matters because paramedics and hospital staff look for the official form.
Your parent's physician needs to sign the order. This is not something you can create on your own or have your parent sign without medical oversight. The doctor needs to assess whether a DNR order is appropriate given your parent's current health. Usually this is straightforward. A physician for someone with stage four cancer or advanced dementia, someone whose death is approaching, will discuss DNR orders as routine. For someone who's healthier, the conversation is different.
The DNR order takes effect immediately once it's signed, dated, and properly executed. There are usually specific witnessing requirements. Some states require notarization. Some require witnesses who aren't family members. The exact requirements depend on your state, which is why you need to check your state's specific regulations or talk to an attorney who knows your state's laws.
Once a DNR order exists, your parent can revoke it at any time. They can change their mind. They can tear it up and say they want CPR attempted. That choice is always theirs, as long as they have the mental capacity to make it. If they lose capacity, the order stands unless it's already been revoked.
Your Parent's Specific Situation
The question of whether your parent should have a DNR order is really a question about their values and their health. These conversations are difficult. Many adult children approach them terribly because we've been taught that talking about death is morbid or pessimistic. It's not. It's practical.
You need to understand your parent's health trajectory. What do their doctors say about their diagnosis and prognosis? If they have a terminal illness, the conversation is clearer. If they're generally healthy but older, the conversation is different. If they have dementia, you need to ask the question sooner rather than later, while they can still make their own decision.
The next question is about your parent's values. What matters to them? Some people say they want everything done, no matter what. Some people say they want CPR only if it's a sudden event and they could realistically recover to a meaningful life. Some people say they don't want CPR under any circumstances. There's no right answer. There's just their answer.
Ask directly. "If your heart stopped, would you want us to do chest compressions and resuscitation?" Listen to what they say. Many people are relieved to have this conversation because they've been worried about ending up in the situation your mother ended up in.
You'll also need to understand what documentation your parent has. Do they already have a living will or an advance directive that addresses this? Many advance directives include a statement about CPR. You don't need a separate DNR order if your advance directive already clearly states your parent doesn't want resuscitation. But a DNR form is more portable. A DNR form doesn't require anyone to read and interpret a document. It's immediately clear to anyone who sees it.
Your parent will need to provide the signed and completed form to their healthcare providers. It should go in their medical chart. A copy should be posted somewhere visible in their home. A copy should be with them in their wallet or easily available. Some areas have registries where DNR orders are recorded so that paramedics can look them up by name or ID number.
Taking Next Steps
If your parent needs a DNR order, the first step is to talk with their primary care physician. Bring up the conversation. Your parent's doctor can assess whether a DNR order is appropriate and can provide the correct form for your state. If your parent's doctor seems dismissive of the conversation, that's a flag that you might need a different doctor.
In some cases, you might want to involve an elder law attorney. This is not always necessary. For straightforward situations, your parent's doctor can handle it. But if there are complications,if your parent seems confused about what they're choosing, if there's family disagreement about whether a DNR order is a good idea, if your parent is losing capacity and hasn't yet expressed their wishes clearly,an attorney can help make sure everything is done correctly.
The timeline for this depends on your parent's health. If they have recently received a serious diagnosis or have clear decline, this should be done soon. If your parent is generally healthy and you're planning ahead, you can schedule the conversation with their doctor at their next appointment. Don't wait for an emergency. Emergencies are when you don't have a choice about what happens to your parent's body.
Keep copies. Multiple copies. One in your parent's medical chart, one on the refrigerator, one in their wallet, one with you. Make sure everyone involved in your parent's care knows where it is. If your parent moves to assisted living or a nursing home, the facility needs to have a copy.
This is one of those pieces of planning where you're not taking control. You're enabling your parent to maintain control over their own body. You're making sure their wishes are honored when they can't advocate for themselves. That matters.
How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.