What is the medical term DNR

Do-not-resuscitate arrangement

from English: do not - omit; resuscitate - revive
Synonyms: DNR order, DNR order, DNR, allow natural death

1 definition

A Do-not-resuscitate arrangement, short DNR arrangement, is an oral or written instruction to medical staff that a person does not want to receive cardiopulmonary resuscitation (CPR) in principle.

see also:Do-not-intubate (DNI)

2 background

Due to the increasing possibilities of life extension, the question of not taking such measures becomes relevant. A DNR order should serve to implement the patient's wishes in emergency situations. Currently (2019) there are no generally known guidelines or guidelines on the DNR arrangement. There are different assessments of whether further examinations or treatments should be avoided in addition to CPR. A DNR arrangement in the broader sense often also means limiting the scope and invasiveness of the treatment to a "sensible" level. In addition to the patient's request, the medical hopelessness of measures to achieve a therapeutic goal can also be a justification for a DNR order.

3 legal situation

A DNR order may only be issued by an experienced doctor, in the clinic usually by a specialist, in the outpatient area primarily by the treating family doctor. In addition to the patient, family members and caregivers should be included in the decision. In the conversation, the illness situation, prognosis and therapy goals are discussed and a doctor's recommendation is given.

The DNR arrangement must be designed in such a way that the content can be grasped quickly and clearly even under time pressure. In principle, they should be given a period of validity and re-evaluated at certain time intervals. A DNR order is not valid if the recipient of the message has relevant doubts as to its validity or authenticity. Each time the prognostic situation or framework conditions change, a reassessment is necessary.

The DNR order is not a living will, as it does not serve the general expression of the patient's wish, but is only created with regard to a current occasion, i.e. if a cardiac arrest is likely due to an illness, for example. The principle applies: in good time, but not prematurely.

4 Risks of a DNR order

The misjudgment of the patient's prognosis can lead to the omission of any necessary measures. Due to a misunderstanding of palliative medicine, a DNR order can lead to excessive restrictions in patient care. Refraining from CPR is not to be equated with not using curative therapy.

5 literature