Do - not - resuscitate order after 25 years * Jeffrey

More than twenty-five years ago, the first hospital policies on orders not to resuscitate were published in the medical literature (1–3). As it was then, few initials in medicine today evoke as much symbolism or controversy as the DNR (donot-resuscitate) order. The development of the DNR order marked a pivotal change in the delivery of medical care, for instead of instructing others to deliver treatment, it was the first order to direct the withholding of treatment. The DNR order has since become a part of the ritual of death in our society, so commonplace that nearly all physicians have written one, or have been ordered to adhere to one, at some point in their career. For the patient, a DNR order, or the absence of a DNR order, establishes how death will likely ensue. More broadly, the DNR order has served both as a harbinger and symbol of our society’s ongoing struggle to answer two fundamental questions about foregoing medical treatment at the end of life: when is it appropriate, and who is to decide? In this article, we review the development, implementation, and present standing of the DNR order.