As a 22‑year‑old, how can I obtain a Do‑Not‑Resuscitate (DNR) order and what are the eligibility criteria?

Obtaining a DNR Order as a 22-Year-Old

As a 22-year-old with decision-making capacity, you can obtain a DNR order at any time through a documented discussion with a physician—there are no age restrictions or terminal illness requirements for competent adults who wish to refuse CPR. 1

Legal Framework and Eligibility

• Any adult with decision-making capacity has the legal and ethical right to request a DNR order, regardless of age or health status. 1, 2
• The only requirement is that you can understand your medical situation, treatment options, and communicate your preferences clearly. 3
• Your directly expressed wishes supersede any surrogate decision-maker's preferences, including family members or those holding durable power of attorney. 4

How to Obtain a DNR Order

Step 1: Initiate Discussion with Your Physician

• Schedule a conversation with your primary care physician or any licensed physician who can write the order. 1
• The discussion typically takes 15-20 minutes in most cases. 5
• Be prepared to discuss your values, goals, and preferences regarding end-of-life care. 3

Step 2: Required Documentation

The physician must complete a written DNR order that includes: 1, 3

• A clear statement of your decision-making capacity at the time
• The date of DNR order implementation
• Your signature (as you have capacity)
• Physician signature, date, and documentation of the discussion
• Specific instructions about which interventions are to be withheld (chest compressions, defibrillation)

Step 3: Clarify Scope of the Order

Critical: A DNR order does NOT limit other medical treatments unless you specifically request additional limitations. 1, 3

The DNR order should explicitly state that it does not preclude: 1, 3

• Supplemental oxygen
• Intravenous fluids
• Pain management
• Antibiotics
• Vasopressors
• Other comfort measures and medical interventions

Important Distinctions

DNR vs. DNI (Do Not Intubate)

• DNR and DNI are separate orders that must be documented independently. 6
• You can have a DNR without DNI (meaning you would accept intubation for respiratory failure but not chest compressions for cardiac arrest). 3
• You can have DNI without DNR (meaning you would accept chest compressions but not intubation). 6
• Be explicit about which interventions you want to refuse. 3

DNR vs. Advance Directives

• A DNR order is a specific medical order, not an advance directive. 3
• DNR orders apply immediately and are active medical orders in your chart. 1
• Advance directives (living wills, healthcare power of attorney) are broader documents that guide care when you cannot make decisions. 1

Out-of-Hospital DNR Orders

For the DNR to be valid outside the hospital, you need a separate out-of-hospital DNR order. 1

• Regulations vary by state—check your state's specific requirements. 1
• Some states use POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) forms. 1
• These portable medical orders must be accessible to emergency medical services (EMS) personnel. 1

Review and Modification

• DNR orders can be revoked or modified at any time by you. 3
• The order should include a statement about when it should be reviewed (such as with significant change in condition). 3
• You maintain complete autonomy to change your mind. 4

Common Pitfalls to Avoid

• Oral DNR orders are never acceptable—they must be written. 3
• Don't assume a DNR order limits access to intensive care or other treatments—it only applies to CPR during cardiac arrest. 7
• Ensure the order is documented in all care settings where you receive treatment. 1
• If you have surgery planned, the DNR order should be reviewed beforehand with the anesthesiologist and surgeon to determine if it remains in effect during the procedure. 3

Practical Considerations

• You do not need to be terminally ill or have any specific medical condition to request a DNR order. 2
• The physician should explain the probability of surviving cardiac arrest and what CPR entails, but ultimately respects your autonomous decision. 1
• Consider discussing your decision with family members to avoid confusion later, though their agreement is not legally required. 1
• Keep copies of out-of-hospital DNR documentation accessible (wallet card, posted at home, with family members). 1