Guidance for Individuals with a DNR Order
The Illinois Department of Public Health (IDPH) Uniform Do-Not-Resuscitate (DNR) Advance Directive can be used to create a physician order that reflects an individual’s wishes about receiving cardiopulmonary resuscitation (CPR). The form allows you, in consultation with your health-care professional, to make advance decisions about whether CPR should be administered if your breathing and/or heartbeat stop. CPR, when successful, restores heartbeat and breathing. The completed form is intended to be honored across various settings, including hospitals, nursing homes, and by emergency medical services personnel in your residence or en route to a health-care facility. You should use the IDPH Uniform DNR Advance Directive to replace the previous orange-colored Emergency Medical Services DNR form.
You should complete the IDPH Uniform DNR Advance Directive only after extensive discussion about treatment preferences with your immediate family members and your health-care professional. Items for discussion with your health-care professional should include your preferences regarding administration of CPR if your heartbeat and/or breathing stop, in view of the following:
- Your personal views
- Your medical condition and related medical considerations
- Your views regarding use of CPR in the event of an unforeseen accident (such as a car crash or choking on food)
- Quality of life issues before and after CPR
- Your views regarding use of CPR during surgery or other medical procedure
- Your wishes regarding organ donation
- Your views regarding use of a mechanical ventilator
You are not required to consent to a DNR order as a condition of treatment or care. If you become unable to make decisions for yourself, a decision regarding whether you should have a DNR order can be made by your legal representative and your physician.I. General Considerations
What is a Do-Not-Resuscitate (DNR) order?
A Do-Not-Resuscitate (DNR) order is a medical treatment order that says cardiopulmonary resuscitation (CPR) will not be attempted if your heart and/or breathing stops.
What is cardiopulmonary resuscitation (CPR)?
CPR refers to various medical procedures, such as chest compressions, electrical shocks and insertion of a breathing tube, used in an attempt to restart your heart and/or breathing.
Why are DNR orders issued?
Health-care professionals ordinarily will begin CPR when your heart and/or breathing stop. You may make a choice, however, not to receive CPR under these circumstances. A DNR order states you prefer to be cared for without CPR in the event your heart and/or breathing stops.
Who may have a DNR order?
An adult or an emancipated minor who does not wish to have CPR attempted when his or her heart and/or breathing stops may have a DNR order. The parent or legal guardian of a minor also may request a DNR order for the minor.
Is there a form my physician can use to enter a DNR order?
The Illinois Department of Public Health (IDPH) has developed the “IDPH Uniform Do-Not-Resuscitate (DNR) Advance Directive” that your physician can use. A DNR order completed on this form should be honored by health-care professionals and providers in health-care facilities, as well as by EMTs and paramedics in your home or en route to a health-care facility. To obtain a copy of the IDPH Uniform DNR Advance Directive, you may request one from your health-care professional or facility. Copies also are available on the Illinois Department of Public Health’s Web site located at www.idph.state.il.us/public/books/advin.htm. Health-care facilities also may have their own form, but this guidance addresses only the IDPH Uniform DNR Advance Directive.
Where may a DNR order be used?
A DNR order may be used by all health-care professionals and providers. If you choose to use the IDPH Uniform DNR Advance Directive, it is required by law to be honored in licensed hospitals, in certain licensed long-term care facilities such as nursing homes, and by licensed emergency medical services personnel.II. Completing and Reviewing the IDPH Uniform DNR Order Form
On the IDPH Uniform DNR Order Form, what is meant by “full cardiopulmonary arrest”?
Full cardiopulmonary arrest means both your heart and breathing have stopped.
On the IDPH Uniform DNR Order Form, what is meant by “pre-arrest emergency”?
Pre-arrest emergency means your breathing is labored or stopped, but your heart is still beating. If CPR is not initiated, full cardiopulmonary arrest may follow a pre-arrest emergency.
The IDPH Uniform DNR Order Form identifies two options you may select in the event of a “pre-arrest emergency.” What is the difference between the two options?
The first option is “ Do Attempt Resuscitation,” which means CPR will be attempted if your breathing is labored or stopped.
The second option is “ Do Not Attempt Resuscitation.” This option says you do not want CPR attempted if your breathing has become labored or stopped, but your heart is still beating. The care provided in this category is intended to keep you comfortable and promote your dignity during the emergency, rather than to prolong your life.
If I want all resuscitation efforts under all circumstances, do I still have to complete the IDPH Uniform DNR Order Form?
No. If you do not have a completed DNR order, CPR should be attempted if your heartbeat and/or breathing stop.
If I do not have a completed DNR order, what will happen if I suffer some type of cardiopulmonary arrest?
Again, CPR should be attempted in the event your heart and/or breathing stop.
Who may provide the consent required on the IDPH Uniform DNR Order Form?
Generally, consent may be obtained from you or another person legally authorized to act on your behalf. If you are unable to make your own health-care decisions, a legal guardian, a health-care agent under a health-care power of attorney or a health-care surrogate may consent on your behalf to the DNR order. A parent or legal guardian typically may grant the required consent for a minor, and emancipated minors also may consent to a DNR order.
Does the IDPH Uniform DNR Order Form require the signature of the person who is consenting to the DNR order?
Yes. You or your legal representative, health-care agent or health-care surrogate must sign the section of the form concerning consent.
Is a witness required for the IDPH Uniform DNR Advance Directive?
Yes. One individual, 18 years of age or older, must witness your signature or your legal representative's signature granting consent on the IDPH Uniform DNR Advance Directive. A witness may include a family member, friend or health-care worker.III. Implementing a Completed IDPH Uniform DNR Order Form
Once I have a completed DNR order on an IDPH Uniform DNR Advance Directive, what medical care will be given to me?
When the DNR order is entered into your medical record, you will continue to receive appropriate medical care. However, if your heartbeat and/or breathing stops, appropriate medical treatment will only be given to you according to your wishes as expressed in the IDPH Uniform DNR Advance Directive.
Does the cause of the cardiopulmonary arrest matter when invoking my DNR order?
Generally, no. The order generally applies when your heartbeat and/or breathing stop, regardless of what caused the cardiopulmonary arrest. For example, if you go into cardiopulmonary arrest from an accident, and you have a DNR order, your wishes as stated in the order likely will be followed to the extent the order is readily available to the health-care provider.
A DNR order may not be appropriate for you, should you want CPR administered if your heartbeat and/or breathing stop as a result of an accident or during a medical procedure such as surgery. Therefore, it is very important to discuss your wishes with your health-care professional prior to consenting to a DNR order. You and your health care professional might want to consider placing your wishes regarding application of the order in the event of an accident or medical procedure in the portion of the form designated for other instructions.
What if I change my mind about having a DNR order?
You (or your legal representative on your behalf) can change your mind at any time about having a DNR order. The DNR order can be revoked in a variety of ways, such as by writing “VOID” in large letters across the front of the form. If you revoke a DNR order, you also should tell your family members, as well as each health-care professional and provider that has received a copy of the order. You may then choose not to have a DNR order, or you may choose to complete a new DNR order reflecting any changes you wish.
Does my completed DNR order have an expiration date?
No. The order is valid until you revoke it. If you are unable to revoke it, your legal representative may do so.
Must all health-care providers honor my DNR order?
Licensed hospitals, certain licensed long-term care facilities such as nursing homes, and licensed emergency medical services personnel are required by law to honor a DNR order completed on the IDPH Uniform DNR Advance Directive.
If an ambulance is called to take me to the hospital, should my DNR order be honored by licensed emergency medical services personnel?
Yes, as long as someone provides emergency medical services personnel with a copy of your DNR order, and the order appears to be complete and valid. If a form other than the IDPH Uniform DNR Advance Directive is used, however, there may be barriers to honoring your DNR order.
If I am transferred from one facility to another, should my DNR order be sent with me?
Your DNR order,or a copy of it, should accompany you to the next setting, whether it is a hospital, rehabilitation facility, nursing home or your own home.
Are photocopies of the IDPH Uniform DNR Advance Directive valid?
Generally, yes. Photocopies of a completed IDPH Uniform DNR Advance Directive are valid. Each health-care facility, however, may have different policies on whether copies of DNR orders completed on a form other than an IDPH Uniform DNR Advance Directive are accepted as valid. It is advisable to check with a health-care facility regarding its DNR policy.
Who keeps the completed DNR order?
You should keep the original DNR order with you where you reside, whether at home or on file in your medical record at a long-term care facility and your physician should keep a copy in your medical record. A copy also should be with you if you are transported to a hospital or other health-care facility. If you have a legal guardian, have named an agent under a power of attorney for health-care or have a surrogate (substitute) decision maker, he or she also should have a copy of the order readily accessible.
Are DNR orders ever suspended during surgery or other medical procedures?
Certain health-care providers in Illinois have written policies indicating that a DNR order may be suspended during a surgical procedure after discussion with you or your legal representative.
Further, your wishes regarding applicability of a DNR order during surgery, or in the event of an unforeseen accident (e.g. a car crash or choking on food), may be placed on the form in the space designated for “other instructions”.
What other documents might I consider signing to direct my care when I am no longer able to make health-care decisions for myself?
You may choose to make your wishes known by appointing an agent through a power of attorney for health-care or by executing a living will. Read the “Statement of Illinois Law on Advance Directives” for further information regarding the various advance directives available in Illinois. The statement is located on the Illinois Department of Public Health’s Web site at www.idph.state.il.us/public/books/advin.htm. You also can obtain at this Web site the following forms: IDPH Uniform DNR Advance Directive, Health Care Power of Attorney, Living Will and Mental Health Treatment Preference Declaration.
The Illinois Department of Public Health has provided this guidance document for general informational purposes. Because each individual situation is different and key facts can so often change the outcome, additional questions should be directed to a licensed attorney, as IDPH cannot provide legal advice.