Do Not Resuscitate
A DNR, or Do Not Resuscitate Order, is a written directive from a person, their doctor, or someone entitled to make decisions on their behalf, that they should not be revived if they suffer cardiac arrest. This is sometimes known as a no-code order. Instead, the person wishes to have a natural death without painful or invasive medical procedures. This is usually because the person suffers from an inevitably fatal illness, and does not wish to prolong the suffering.The DNR order came into being in the USA in the 1960s when defibrillation allowed the reversal of cardiac arrest, but this may prolong the life of the patient for only a short time.
In the USA, CPR and ACLS should not be performed if a valid written "DNR" order is present. In any cases of doubt, emergency medical technicians, paramedics and other medical workers will perform as if a DNR order did not exist, as is required by law.
For the DNR to be valid there may be rules such as the use of a special form and/or additional signatures of a doctor and/or witnesses, etc. The exact rules for obtaining and for emergency medical personnel accepting the validity of a DNR order vary widely according to jurisdiction. For example, in the state of Maryland, only Maryland-state DNR orders are acceptable, and they require much verification, witnesses and doctor's signatures in order to be valid. In contrast, the state of West Virginia allows patients to receive a DNR order with relative ease, and will accept them from most other jurisdictions.