By Mary McElroy
A do-not-resuscitate (DNR) order is a medical order, signed by a physician, that tells a patient’s care team not to perform CPR if their heart stops or they stop breathing. That is the entire scope of what it does.
A DNR does not mean a patient stops receiving care. Pain medication, oxygen, nutrition, wound care, and every hospice service continue exactly as before. The only thing a DNR changes is the response to one specific event: cardiac or respiratory arrest.
A DNR is also different from a living will. A living will is a legal document describing a range of future treatment wishes, and it only takes effect under conditions a physician has to certify. A DNR is the signed medical order that EMS and hospital staff are required to follow the moment they see it.
You do not need a DNR to receive hospice care. Community Hospice & Palliative Care, like every Medicare-certified hospice, does not require a DNR for admission. Many families decide later, on their own timeline, as part of ongoing care planning.
And you can change your mind. A DNR can be revoked at any time, verbally or in writing, and no explanation is required.
What a DNR Order Actually Stops (and What It Doesn’t)
CPR, cardiopulmonary resuscitation, is the specific set of interventions used when someone’s heart stops or they stop breathing: chest compressions, rescue breathing, defibrillation (an electric shock meant to restart the heart), and intubation to place someone on a breathing machine. A physician-signed DNR order tells the care team to withhold exactly those interventions. Nothing more.
Here is the myth that causes the most confusion, and the most fear: that a DNR means “do not treat.” A DNR order does not mean “do not treat.” Patients with a DNR still receive pain management, comfort care, and every other hospice service exactly as before. Medications continue. Antibiotics continue if the care team and family have already agreed to use them. Nutrition, hydration, and every scheduled hospice visit continue exactly as planned.
A related fear deserves its own answer: signing a DNR does not mean giving up. A DNR changes the response to one event, cardiac or respiratory arrest, and nothing about the level of attention or care a patient receives day to day.
Real-world CPR is also far less effective than television makes it look, particularly for patients who are already seriously ill. Research published by the National Institutes of Health shows that outcomes drop sharply the longer resuscitation efforts continue, and even when CPR succeeds mechanically, it often means broken ribs, intubation, and no change to the underlying illness.
You may also hear the terms DNAR (do not attempt resuscitation) or AND (Allow Natural Death) from a physician or nurse. Some clinicians prefer these phrases specifically because “do not resuscitate” can sound like it means more than it does. They describe the same order. This guide uses “DNR” because it’s the term most families recognize, but if your care team uses DNAR or AND, know they’re talking about the same order.
DNR vs. Living Will: Two Different Documents, Two Different Jobs
| DNR Order | Living Will | |
|---|---|---|
| What is it | A medical order, signed by a physician | A legal document stating future treatment wishes |
| Who signs it | A physician (or in Florida, an osteopathic physician, autonomous APRN, or physician assistant), plus the patient or their surrogate | The patient, signed and witnessed according to state law |
| When does it apply | Immediately, the moment a patient’s heart or breathing stops | Only once a physician certifies specific conditions have been met (in Florida: persistent vegetative state, end-stage condition, or terminal condition) |
| Who must follow it | EMS, hospital staff, and the care team, on sight | Guides medical decisions once triggered, but isn’t something a paramedic can act on directly |
Unlike a living will, which is a legal statement of future wishes, a DNR is an active medical order that EMS and hospital staff are required to follow the moment they see it. The practical trap many families fall into: they have a living will at home and assume that alone will stop CPR from being attempted. The living will won’t, not in an emergency. If the goal is making sure CPR isn’t attempted, the family needs the signed DNR form itself, kept visible and accessible, not just a living will describing wishes in general terms.
A DNR, a living will, and a health care surrogate designation are all examples of what’s broadly called an advance directive: paperwork that puts your wishes, or your decision-maker, in place before a crisis happens.
DNR vs. Health Care Surrogate and POLST: Other Documents Families Confuse With a DNR
A health care surrogate (sometimes called a health care proxy) is a person, not a set of instructions. The health care surrogate designation is the legal document that names someone you trust to make medical decisions on your behalf if you can’t make them yourself, including decisions about a DNR. A DNR and a living will both give instructions. A health care surrogate names who decides when instructions run out or don’t cover the situation at hand. Florida law, Florida Statutes Chapter 765, requires the surrogate designation to be signed in front of two witnesses, one of whom can’t be your spouse or a blood relative.
POLST stands for Physician Orders for Life-Sustaining Treatment. Like a DNR, it’s a physician-signed medical order, not a legal document, but it covers more ground: CPR, plus preferences around hospitalization, antibiotics, and artificial nutrition. POLST is meant for people with a serious illness or limited life expectancy, and it travels with the patient across care settings, home, hospital, nursing facility, so their wishes are known no matter where they receive care. Florida has run a state POLST Program through the Department of Health since 2019.
If your family already has a living will or a health care surrogate designation, a DNR isn’t a replacement for either. It works alongside them: the living will explains the broader picture, the surrogate designation names who decides, and the DNR is the specific order first responders act on.
How a DNR Order Is Put in Place in Florida
- The conversation happens first. Usually your physician or a member of the hospice team raises the subject, walking through your loved one’s condition, prognosis, and what CPR would realistically accomplish.
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The patient, or their legally authorized decision-maker, agrees to the order. If the patient has the capacity to decide, they sign. If not, a health care surrogate, court-appointed guardian, or person holding a durable power of attorney signs on their behalf.
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A physician signs Florida’s official form, DH Form 1896. In Florida, an osteopathic physician, autonomous-practice APRN, or physician assistant can also sign. Physician sign-off alone isn’t enough; the patient or their representative has to sign too. This requirement comes from Florida Statute 401.45, the law that created the state’s standardized DNR form and identification device system, maintained by the Florida Department of Health.
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The form has to be printed on yellow paper. This isn’t a suggestion. White paper with yellow highlighting does not qualify. Photocopies are valid as long as they reproduce the full yellow background and legible signatures.
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Florida does not use a metal DNR bracelet or necklace. Instead, the form includes a miniature version, called a patient identification device, that can be laminated and carried in a wallet, worn on a chain, or clipped to clothing or bedding.
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Keep the form or device where paramedics will actually see it. EMS checks visible medical alert items during their initial assessment. A DNR filed away in a drawer won’t be seen in time to matter.
How a DNR Works When a Loved One Is on Hospice Care
A DNR isn’t a requirement for hospice care, and it never has been. Community Hospice & Palliative Care, like every Medicare-certified hospice, admits patients with or without one. Your loved one can begin hospice care with a full code status, meaning CPR would still be attempted, and your family can revisit the DNR decision later, on your own timeline.
Most hospice patients do eventually choose a DNR, though it isn’t required. The conversation usually happens during the broader goals-of-care discussion that the hospice interdisciplinary team, physician, nurse, and social worker, has with your family during admission or shortly after. It’s a conversation, not paperwork to sign before care can start.
One detail that surprises families: a hospice physician can write and sign the DNR order directly. That’s often more convenient than coordinating with an outside physician your loved one may not see regularly anymore.
If your family decides a DNR is right, ask your hospice team two practical questions: does the hospice keep a copy of the form on file, and does a copy need to be visible at home in case emergency responders arrive before hospice staff do? Both matter. EMS can only honor a DNR they can see.
Patients with a DNR order still receive the full range of hospice care services: nursing visits, medication management, comfort measures, and family support. Our care team supports about 1,500 patients a day across northeast and north central Florida, and this exact conversation, what a DNR does and doesn’t change, comes up in nearly every one of those cases.
“No one is ever denied services through Community Hospice, regardless of their ability to pay.”
If you haven’t started hospice care yet and you’re trying to figure out whether it’s time, this guide on signs it may be time for hospice can help you think through that first. And if cost is part of what’s holding you back from calling, how Medicare covers hospice explains what’s included.
Questions to Ask Your Hospice Team About a DNR
A few questions can make this conversation easier to have, and easier to revisit later if anything changes:
- What is my loved one’s condition and prognosis, and what would CPR realistically accomplish?
- Does a DNR affect anything besides CPR?
- Who needs to sign this, and does my family member currently have the capacity to decide?
- Where does the form need to be kept so paramedics will see it?
- If my loved one is on hospice, does the team keep a copy, and do we need one visible at home too?
- Can this be changed later if circumstances change?
There’s no wrong time to ask. Your hospice team would rather answer these questions twice than have your family guess.
Common Questions About DNR Orders (FAQ)
What does DNR mean?
DNR stands for do-not-resuscitate. It’s a physician-signed medical order that tells the care team not to attempt CPR if a patient’s heart or breathing stops. It has no bearing on any other kind of medical or hospice care.
Does a DNR order mean no other treatment?
No. A DNR addresses CPR only. Pain management, medications, nutrition, hydration, and every hospice service continue on exactly the same schedule.
Can you change your mind about a DNR after it’s signed?
Yes, at any time. The patient or their health care surrogate can revoke a DNR verbally or in writing, and no explanation is required.
What’s the difference between a DNR and a living will?
A DNR is a specific medical order about CPR that first responders are required to follow on sight. A living will is a broader legal document about future treatment wishes that EMS can’t act on directly in an emergency.
Do you need a DNR to receive hospice care?
No. Hospice admission doesn’t require a DNR. It’s a decision your family can make on its own timeline, often with guidance from the hospice team.
What is a POLST form?
POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a broader physician-signed medical order than a DNR, covering CPR plus other preferences like hospitalization and artificial nutrition, designed for people with a serious illness.
What happens if there’s no DNR order in place?
Without a signed DNR, EMS and hospital staff are generally required to attempt CPR and other resuscitative measures if a patient’s heart or breathing stops, regardless of what the family understands the patient’s wishes to be.
When to Call Community Hospice
You don’t have to sort out a DNR decision by yourself, and you don’t have to decide it today. Our care team can walk your family through this conversation as part of hospice admission or as part of ongoing care, whenever you’re ready to have it.
Call 866-253-6681 to talk with a member of our team. You can ask about a DNR, about hospice eligibility, or about anything else on your mind. It’s a conversation, not a commitment.
Community Hospice & Palliative Care offers a full range of hospice and palliative care services across 16 counties in northeast and north central Florida, and our team is available to help your family figure out the next right step, whatever that looks like for you.
Mary McElroy
Oversees all clinical nursing and nursing assistant functions, including inpatient, home care, long term care, triage and nursing services administration. Mary received a Bachelor of Science in Nursing from Villanova University and a Master of Science in Administration and Health Services from Central Michigan University. In 2003, she was honored as one of the Great 100 Nurses of Northeast Florida.