How to Get a Do Not Resuscitate Card

Getting a Do Not Resuscitate (DNR) card involves understanding your medical preferences, confirming your wishes with a licensed clinician, and ensuring that the document is recognized across care settings. This article explains what a DNR card is, how to obtain one, how it interacts with state laws and POLST/MOLST programs, and practical steps to ensure your wishes are respected in emergencies.

What A DNR Card Is And How It Works

A DNR card is a formal document indicating that a person does not want CPR or advanced resuscitation if their heart stops or they stop breathing. In many states, a DNR is tied to a physician’s order or a state-approved form that travels with the patient. DNR cards are most effective when paired with advance care planning and, in some regions, with POLST/MOLST forms that specify preferences for a range of treatments.

It is essential to recognize that a DNR card does not affect other medical treatments. It specifically addresses resuscitation efforts and does not automatically limit other necessary interventions, such as comfort care or managing symptoms. Individuals should discuss goals of care with their healthcare providers to ensure alignment across all settings.

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When properly completed and recognized, a DNR order prevents health professionals from initiating CPR in the event of cardiac or respiratory arrest, unless the document is not valid in a specific jurisdiction or is overridden by a court order or surrogate decision-maker in certain circumstances.

Who Should Consider A DNR Card

A DNR card is typically considered by individuals with serious, irreversible, or terminal illnesses, advanced age with frailty, or those who prioritize comfort and quality of life over aggressive resuscitation. It may be appropriate for people with a chronic condition where CPR is unlikely to be successful or could cause significant harm or prolonged suffering.

Families and caregivers can benefit from a DNR discussion to reduce confusion during emergencies. However, a DNR decision should reflect the patient’s values and preferences and be revisited if health status changes or after major medical events.

How To Get A DNR Card: Step-By-Step

Step 1: Reflect On Your Goals And Discuss With A Clinician

Identify treatment goals, values, and preferences with a healthcare provider. This ensures the DNR aligns with overall goals of care and does not inadvertently restrict other needed therapies.

Step 2: Verify Your State’s Requirements

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Policies vary by state. Some require a physician’s order; others use a standalone form recognized by emergency responders. Check with your hospital, primary care physician, or state health department for the exact process.

Step 3: Complete The Appropriate Form Or POLST/MOLST

Fill out the form with clear language about not wanting CPR. If available in your state, consider completing a POLST/MOLST form, which covers a wider range of treatments and is intended to accompany the patient across care settings.

Step 4: Have It Signed By A Physician Or Qualified Clinician

Most jurisdictions require a physician, nurse practitioner, or other qualified clinician to sign the order. Some forms may require witnesses or notarization, depending on state rules.

Step 5: Keep The Original And Copies In Accessible Places

Carry a laminated card or wallet card that displays the DNR status. Provide copies to family members, designated healthcare proxy, primary care physician, and any care facilities you use. Ensure it is accessible to EMS and hospital staff.

Step 6: Review And Update Regularly

Revisit the DNR status after major health changes, new diagnoses, or changes in personal wishes. Update forms as needed and distribute updated copies to relevant parties.

What The DNR Card Covers And What It Does Not

A DNR card specifically addresses cardiopulmonary resuscitation and defibrillation in emergencies. It does not necessarily limit other medical treatments or procedures. In many areas, a DNR is part of a broader advance care planning framework, such as POLST/MOLST, that can specify preferences for ventilation, artificial nutrition and hydration, antibiotics, and symptom management.

In practice, healthcare professionals follow the most current and legally valid directive available. If a patient has a POLST/MOLST, it may supersede a DNR depending on state law. Discuss how these documents interact in your state with your clinician.

Key Considerations When Choosing A DNR Card

  • State Variations: Laws, forms, and recognition vary widely. Always verify local requirements.
  • Clarity: Use explicit language about CPR and rescue procedures to avoid misinterpretation.
  • Signature And Witnessing: Ensure the form is properly signed by a clinician and witnessed if required.
  • Documentation For EMS: Provide EMS with copies of the DNR and any POLST/MOLST forms to ensure immediate recognition in emergencies.
  • Family And Proxy Involvement: Inform designated decision-makers to prevent conflicts and delays during a crisis.

Alternatives And Complements To A DNR Card

POLST/MOLST forms are commonly used as complements to DNR orders, offering a broader, patient-centered set of treatment preferences. Living wills or advance directives specify desired medical treatments if the person cannot communicate, but they are not immediately actionable at the moment of an emergency without accompanying orders.

Healthcare proxies or durable power of attorney for healthcare can appoint someone to make medical decisions when the patient lacks decision-making capacity. This appointment can ensure the patient’s wishes are honored even if the person is unable to communicate.

Common Myths About DNR Cards

  • Myth: A DNR means no medical care at all. Reality: It only addresses resuscitation efforts; other treatments and comfort measures may still be provided.
  • Myth: A DNR is permanent and unchangeable. Reality: DNR status can be updated or revoked at any time with a new form or physician order.
  • Myth: EMS will always honor a DNR. Reality: Validity depends on state laws, proper documentation, and access to the form in an emergency.

Frequently Asked Questions

Do I Need A Doctor’s Signature To Get A DNR Card?

Most states require a physician or qualified clinician to sign the order. Some forms may be initiated by the patient or family but require clinician validation before becoming active.

Can A DNR Be Reversed?

Yes. If a patient wishes to resume life-sustaining measures, a new order or updated POLST/MOLST form can revoke the DNR. Notify all involved care providers and distribute updated documents.

Will My DNR Card Be Recognized In Hospitals, Home Care, And Ambulances?

Recognition varies by jurisdiction and facility. Carry copies and ensure EMS, hospitals, and home health agencies have access to the documents. Consider a laminated wallet card and digital copies where available.

How Does A POLST/MOLST Change The Process?

A POLST/MOLST provides actionable medical orders for a wider range of treatments. If a POLST/MOLST is in place, it will guide emergent care decisions more comprehensively than a DNR alone.

Practical Tips To Ensure Your Wishes Are Respected

  • Discuss Early: Have conversations with family and clinicians before emergencies occur.
  • Document Thoroughly: Use state-approved forms and ensure all signatures are complete.
  • Distribute Widely: Provide copies to your primary care physician, specialists, hospital records, and care facilities.
  • Review Regularly: Reassess your decisions after health changes or new diagnoses.

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