What Is a Do Not Resuscitate Order?

A do not resuscitate order, commonly called a DNR, is a medical order instructing health care providers not to perform CPR if a person's heart stops or they stop breathing. It is different from a living will, and in Washington it usually takes a specific form that emergency responders will honor. For families in Snohomish County making end-of-life plans, understanding what a DNR is, and what it is not, helps ensure a loved one's wishes are actually followed. This topic is part of Washington advance healthcare directives.

A DNR Is a Medical Order, Not a Wish

The most important thing to understand about a DNR is that it is a medical order. Unlike a living will, which is a legal document a person signs to express their future wishes, a DNR is an active instruction to medical personnel about a specific intervention: cardiopulmonary resuscitation. When a valid DNR is in place, providers will not attempt CPR, chest compressions, or related resuscitation efforts if the person goes into cardiac or respiratory arrest. Related guides cover What Is a POLST Form? and What Happens If My Advance Directive Conflicts With Family Wishes?.

A DNR addresses only resuscitation. It does not mean a person is denied other care. Comfort measures, pain relief, and treatment for other conditions continue. The DNR speaks to one question: whether to attempt to restart the heart and breathing. People sometimes fear that a DNR means giving up on care entirely, which is a misunderstanding. It is a focused decision about resuscitation, not a withdrawal of medical support generally.

How DNR Works in Washington: The POLST Form

In Washington, the practical way a person's resuscitation wishes become an actionable, portable medical order is usually through a POLST form. POLST stands for Portable Orders for Life-Sustaining Treatment. It is not a document a patient signs alone; it is a medical order that must be signed by a qualified health care provider, such as a physician, an advanced registered nurse practitioner, or a physician assistant, after a conversation with the patient or their representative.

The POLST form records a person's wishes about resuscitation, expressed as either attempt CPR or do not attempt resuscitation, along with their wishes about other life-sustaining treatments. Because it is a provider's order, it carries immediate medical authority. And because it is designed to be portable, it travels with the patient across settings, from home to an ambulance to a hospital to a long-term care facility, so the same instructions follow the person wherever they receive care.

POLST is intended for people who are seriously ill or frail, often those approaching the end of life, for whom these decisions are concrete and pressing. It is generally not something a healthy young adult needs, which is part of what distinguishes it from the advance planning documents everyone can benefit from.

Why a POLST Is Honored by Emergency Responders

A key advantage of the POLST form in Washington is that emergency medical personnel will honor it outside a hospital. Ordinarily, when someone calls 911 and a patient is in arrest, responders are trained to attempt resuscitation. A valid POLST form changes that, directing EMS to follow the orders it contains, including a do-not-resuscitate instruction. In Washington, the Department of Health recognizes POLST as the approved order set that emergency responders may follow in the community, which is why the form is typically printed on distinctive bright green paper and kept where it can be found quickly, such as on the refrigerator. As a practical matter, responders act on the form itself, not on a bracelet or card alone, so having the actual POLST accessible matters.

DNR Versus a Living Will

It is easy to confuse a DNR or POLST with a living will, but they do different jobs and often work together. A living will, known in Washington as a health care directive under the Natural Death Act, chapter 70.122 RCW, is a legal document a competent adult signs in advance to state their wishes about life-sustaining treatment if they later have a terminal condition or become permanently unconscious. It speaks to the future and guides decisions, but it is not itself an order that EMS acts on in the moment.

A DNR, expressed through a POLST in Washington, is a current medical order that providers and emergency responders act on immediately. In short, a living will tells the world what you would want; a POLST turns those wishes into present medical orders a provider has signed. Many people benefit from both: a health care directive to express their broader wishes and, when they become seriously ill, a POLST to convert those wishes into actionable orders. The two complement rather than replace each other.

Making Sure Your Wishes Are Followed

The value of any of these documents lies in their being honored, which means they have to be properly prepared, accessible, and consistent with each other. A POLST should reflect a genuine conversation with a provider and the person's actual wishes. A health care directive should be in place and findable. And it helps to name a health care agent through a durable power of attorney for health care, so a trusted person can speak for you and apply your wishes to situations no document anticipated. When these pieces line up, families are spared agonizing guesswork during a crisis.

End-of-life planning is deeply personal, and the legal and medical tools work best when they fit together into a clear plan. If you want to make sure your wishes about resuscitation and life-sustaining treatment are documented and will be respected, the Law Office of Chad Foster can help Snohomish County families put the right combination of documents in place, including health care directives and powers of attorney that work alongside a POLST. Reach out to start the conversation.

This is a sensitive subject, and these are personal decisions. This article is general legal information about Washington law, not legal or medical advice for your specific situation. For the medical aspects of a DNR or POLST, talk with your health care provider.