Do not resuscitate order aka DNR

What is a Do Not Resuscitate Order DNR


Often times clients ask me about getting a do not resuscitate order aka DNR.  The first thing you must know about these orders is that the order instructs a health care professional not to attempt cardiopulmonary resuscitation, transcutaneous cardiac pacing, defibrillation, advanced airway management, and artificial ventilation on a patient whose circulatory or respiratory function ceases.  Second, DNRs are not documents prepared by estate planning attorneys.  Do not resuscitate orders are issued by doctors and thus they must be signed by a doctor.  The third thing is that there are two kinds of DNRs:  one issued by a health care facility and an out-of-hospital DNR.    Texas has a required form that must be used.


Requirements for a valid DNR


The requirements for a valid DNR are simple.  The order must be issued by the patient’s attending physician, dated.  In addition to those requirements, a valid DNR must be written by someone competent at the time the document was made.  A patient can give oral instructions, but those instructions must be witnessed by two competent adults that are not the attending physician or employed by the health care facility.  If the person has an advance directive a DNR can be issued in compliance with it by the patients attending physician.  An agent under a medical power of attorney or a legal guardian may give directions regarding a DNR pursuant to their authority.  If the patient does not have a medical directive, an agent under a medical power of attorney, or a legal guardian and is incompetent or can not communicate then a family member, along with the attending physician can make a decision on behalf of the patient withdraw or withhold life sustaining treatment.


If there is a conflict between an advance directive and the DNR order, the document executed or issued most recently controls.  The DNR must be placed in the patient’s medical records as soon as possible.


Out-of-hospital DNR


Texas law defines out-of-hospital as a location in which health care professionals are called from assistance, including long-term care facilities, in-patient hospice facilities, private homes, hospital outpatient or emergency departments, doctor’s offices, and vehicles during transport. 


A competent person may at any time execute a written out-of-hospital DNR order directing health care professionals acting in an out-of-hospital setting to withhold cardiopulmonary resuscitation and certain other life-sustaining treatment.  You must sign the order in front of two witnesses one of whom should not be related to you or have it notarized.  Your doctor must sign the order as well.  This document is effective upon execution.  It is effective until it is revoked either in writing or orally.

Do you remember Dr. Death (Kevorkian)?


The law is Texas does not permit assisted suicide or “mercy” killing.  Texas law does not make it a criminal offense for a person to withhold cardiopulmonary resuscitation or certain other life-sustaining treatment pursuant to a do not resuscitate order. 


How to ensure your out-of-hospital DNR is honored


While you may have taken the time to get an out-of-hospital DNR in place, if the EMS responder’s do not know about it then your desires and plans will not be honored.  The easiest way to ensure emergency medical personnel know you have a DNR is to wear a DNR identification bracelet or necklace.  Texas law deems this conclusive evidence that you have a valid out-of-hospital DNR.  Without this device on your person, it can be difficult for emergency medical personnel to quickly assess if your out-of-hospital DNR is valid. 


First EMS must establish your identity as the person who executed the document or had it issued.  They must then look at the form to make sure names and signatures and other information required on the form is present.  They must also look to ensure the date is in the proper place on the form and your and your doctor’s signature or electronic signature is in the appropriate place.  That is a lot to have to do in an emergent health crisis.  Practically speaking, what is likely to happen is that they will perform CPR on you until this other information can be confirmed.  A hard copy of the form must be available and must go with you when you are transported.  A paper copy is required.  A photo on your phone does not count.


Here’s a list of vendors to order a DNR device:


Approved Manufacturers for Vinyl Bracelets

Texas Medical Association
ATTN: DNR form
401 W. 15th Street
Austin, Texas 78701
Order line: 

Approved Manufacturers for Metal Devices

American Medical Identifications, Inc.
Suite 100
949 Wakefield
Houston, Texas 77018
(800) 363-5985

MedicAlert Foundation, Inc.
2323 Colorado Ave.
Turlock, California 95382
(888) 755-1448


Caring Advocates 
2730 Argonauta St
Carlsbad, California 92009
(800) 647-3223


StickyJ Medical ID
10801 Endeavour Way #B
Seminole FL 33777
(866) 497-6265
Email: CustomerService@StickyJ.com

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