An individual, his or her healthcare agent, or a family member (as provided by state law), can agree to a DNR order. Although policies may differ, in general a DNR order must first be discussed with the patient if he or she has the capacity to make medical decisions. If the patient is incapacitated and is unable to make this decision, a physician can then consult instructions in a living will or speak with an appointed healthcare agent. If there is no written advance directive, a physician might consult a family member or a close friend of the patient.
Sometimes, physicians are reluctant to start discussions about DNR orders. Patients and their families should take the initiative to approach the physician about a DNR order, if they think it might be appropriate, and not wait for the physician to raise the issue. When should a DNR order be discussed with a physician?
If a person is seriously ill or dying, discuss a DNR order with the physician as soon as possible. Ideally, a decision about a DNR order should be made while a person is alert and able to think clearly, and not at the last moment when he or she may be weak and disoriented from the illness.
However, if a person does not have the capacity to make a decision about a DNR order, it is important that this discussion be initiated as soon as possible. Ideally the physician would raise the issue, but the family or healthcare agent should not hesitate to approach the physician with their concerns. A discussion initiated sooner rather than later gives patients and their families time to reflect on the decision and, in the end, offers the best protection against unwanted treatment.