A do not resuscitate order (commonly referred to as a DNR or DNRO) is governed by FAC 64J-2.018 which provides the procedure for instructing paramedics and emergency room doctors to refrain from conducting CPR in the event of cardiac arrest or respiratory arrest. DNRs are typically utilized by someone with an end-stage disease, terminal condition or in a persistent vegetative state.
The DNRO is useless unless it is available. Emergency medical personnel do not have time to ask where a DNR may be located - so it should be placed in an easily-identifiable area. If the DNRO patient is in an institution such as an ALF, nursing home, or even an extended stay in a hospital, the DNR should be presented to the facility’s risk management or legal office so the DNR can be prominently-placed in the medical file. If the DNR patient is at home, the do not resuscitate order should be placed somewhere prominently where paramedics or other EMS personnel would easily see the yellow DNRO document (some suggest taping it at the foot of the patient’s bed or on the wall closest to the patient’s bed). The bottom half of the DNR form can be detached (more on that below), laminated and attached to a necklace.
Requirements for a Do Not Resuscitate Order
A DNR order is a single-page form document that has been approved by the Florida Department of Health (link to printable DNR form is below under “Incapacity Planning Lawyer Resources”).
The DNRO will list the patient’s full legal name. Underneath are the words: “Based upon informed consent, I, the undersigned, hereby direct that CPR be withheld or withdrawn.” There is then space to check whether the DNR form is being signed by the patient him/herself or a health-care surrogate, court-appointed guardian, health-care proxy, or durable power of attorney.
Beneath this statement is a place for the patient’s physician to also sign and indicate that the doctor agrees with the patient’s decision to withhold or withdraw CPR, artificial ventilation, cardiac compression, endotracheal intubation, and defibrillation) in the event of cardiac or respiratory arrest.
The do not resuscitate order form then has a dotted line – underneath the dotted line is the same information as above, but is meant to be cut off and placed in a wallet.
Both the patient (or their surrogate, durable power of attorney, etc…) AND the patient’s doctor must sign. The only other DNR requirement is: yellow paper.
The DNR form must be printed on yellow-colored paper
Some people find it odd that the DNRO must be printed on yellow paper – but this is in fact a requirement, which should be respected. DNRs printed on plain white paper (or any other color but yellow), even if utilizing the exact Florida Department of Health Form – need not be honored by paramedics or emergency medical personnel!
The yellow form is actually an advantage. Because there is no specifically-designated place to record the Do Not Resuscitate Order, the point is for the DNRO to be easily identifiable by EMS, paramedics or emergency room doctors. The yellow allows this form to stand out from a volume of other paperwork.
Copies of this form can be made (as long as copies are also on yellow paper).
Difference Between DNR / DNRO and Living Will
The Do Not Resuscitate Order (DNR / DNRO) is a doctor’s order that is very limited in its scope: a DNR only concerns refusing emergency CPR. Living Wills address a host of other end-of-life issues and decisions that our elder law client’s wish to make while they have the capacity to do so.
A DNRO requires a doctor’s signature to have any effect. Living Wills do not require a doctor’s signature, they only require that the client have the capacity to make their end-of-life wishes known and must be signed in the presence of two witnesses.
A DNR is a one page yellow piece of paper provided by the Florida Department of Health. Living Wills can be longer, personalized, documents that get into significantly more detail (as a side note, the color of paper a living will is printed on is unimportant).
Living Wills should also be presented to institutions and medical doctors to be made part of the patient’s medical records.
Who Needs a DNR / DNRO?
Most people want to leave this world as peacefully as possible. The primary job of emergency medical personnel and paramedics is to do whatever they can to keep their patient alive. But, the harsh reality is that most of these emergency life-saving procedures are incredibly painful (e.g. CPR, artificial ventilation, cardiac chest compressions, endotracheal intubation, and defibrillation).
For example, chest compressions regularly result in cracked or broken ribs. Intubation forces a tube down one’s throat or through their nostrils, it has been described as very painful and some people regularly vomit as a result of the foreign substance forced and then lingering down their throat (its usually performed under sedation in non-emergency contexts). We’re all familiar with defibrillators where a sudden electric current is jolted into the chest. The pain has been described as being kicked by a mule in the chest or akin to bomb going off inside.
For those younger and in generally good health, this pain is worth enduring in exchange for a significantly-longer life to live.
So, a DNR is really only appropriate for those who are already near the end of their life and do not wish for it to be prolonged (for likely for a very short period of time) in a manner that is painful.
To learn more about Do Not Resuscitate Orders, talk to your treating physician or a local elder law attorney.
Incapacity Planning Lawyer Resources
Florida Department of Health Form 1896 | Do Not Resuscitate Order – printable form (print on yellow paper only).
Florida Administrative Code on Do Not Resuscitate Orders (FAC: 64J-2.018)
Read about other types of advanced health care directives.
Read a summary of Florida Statutes Chapter 765 (concerning living wills, health care surrogates)