Editing Do not resuscitate (section)

== Terminology ==
''DNR'' and ''Do Not Resuscitate'' are common terms in the United States, Canada, and New Zealand. This may be expanded in some regions with the addition of ''DNI'' (Do Not Intubate). DNI is specific for not allowing the placement of breathing tubes.<ref>{{Cite web |date=2014-10-17 |title=DNR/DNI/AND {{!}} CureSearch |url=https://curesearch.org/understanding-childrens-cancer/coping-with-cancer/palliative-care/dnrdniand/,%20https://curesearch.org/understanding-childrens-cancer/coping-with-cancer/palliative-care/dnrdniand/ |access-date=2022-09-12 |website=curesearch.org |language=en-US }}{{Dead link|date=February 2024 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> In some hospitals ''DNR'' alone will imply no [[tracheal intubation|intubation]],<ref>{{Cite journal|last1=Breu|first1=Anthony C.|last2=Herzig|first2=Shoshana J.|date=October 2014|title=Differentiating DNI from DNR: Combating code status conflation: Differentiating DNI From DNR|url=http://www.journalofhospitalmedicine.com/jhospmed/article/126942/differentiating-dni-dnr|journal=Journal of Hospital Medicine|volume=9|issue=10|pages=669–670|doi=10.1002/jhm.2234|pmc=5240781|pmid=24978058}}</ref> though 98% of intubations are unrelated to cardiac arrest; most intubations are for pneumonia or surgery.<ref name="esteban">{{Cite journal |last=Esteban |title=Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation<SUBTITLE>A 28-Day International Study</SUBTITLE> |date=2002 |url=https://jamanetwork.com/journals/jama/articlepdf/194560/jce10020.pdf |journal=JAMA |volume=287 |issue=3 |pages=345–55 |doi=10.1001/jama.287.3.345 |pmid=11790214 |doi-access=free }}</ref> Clinically, the vast majority of people requiring resuscitation will require intubation, making a DNI alone problematic. Hospitals sometimes use the expression ''no code'',<ref name=":2">{{Cite web|title=Medical Definition of NO CODE|url=https://www.merriam-webster.com/medical/no+code|access-date=2021-12-23|website=www.merriam-webster.com|language=en}}</ref> which refers to the jargon term ''code'', short for ''[[Hospital emergency codes#Code Blue|Code Blue]]'', an alert to a hospital's resuscitation team. If a patient does want to be resuscitated, their code status may be listed as ''full code'' (the opposite of DNR). If the patient only wants to be resuscitated under certain conditions, this is termed ''partial code.''<ref>{{Cite journal|last1=Downar|first1=James|last2=Luk|first2=Tracy|last3=Sibbald|first3=Robert W.|last4=Santini|first4=Tatiana|last5=Mikhael|first5=Joseph|last6=Berman|first6=Hershl|last7=Hawryluck|first7=Laura|date=June 2011|title=Why Do Patients Agree to a "Do Not Resuscitate" or "Full Code" Order? Perspectives of Medical Inpatients|journal=Journal of General Internal Medicine|language=en|volume=26|issue=6|pages=582–587|doi=10.1007/s11606-010-1616-2|pmid=21222172|pmc=3101966}}</ref>

Some areas of the United States and the United Kingdom include the letter A, as in ''DNAR'', to clarify "Do Not ''Attempt'' Resuscitation". This alteration is so that it is not presumed by the patient or family that an attempt at resuscitation will be successful.

As noted above in [[#Less care for DNR patients|Less care for DNR patients]], the word "resuscitation" has grown to include many treatments other than CPR, so DNR has become ambiguous, and authors recommend "No CPR" instead.<ref name="malhi"/> In the United Kingdom the preferred term is now ''DNACPR'',<ref name=":1" /> reflecting that ''resuscitation'' is a general term which includes ''cardiopulmonary resuscitation'' as well as, for example, the administration of intravenous fluid.<ref>Resuscitation Fluids | NEJM</ref>

Since the term DNR implies the omission of action, and therefore "giving up", a few authors have advocated for these orders to be retermed ''[[Allow natural death|Allow Natural Death]]''.<ref>{{cite journal | vauthors = Mockford C, Fritz Z, George R, Court R, Grove A, Clarke B, Field R, Perkins GD | title = Do not attempt cardiopulmonary resuscitation (DNACPR) orders: a systematic review of the barriers and facilitators of decision-making and implementation | journal = Resuscitation | volume = 88 | pages = 99–113 | date = March 2015 | pmid = 25433293 | doi = 10.1016/j.resuscitation.2014.11.016 | url = https://www.researchgate.net/publication/265388139 }}</ref><ref>{{cite web | first = Chuck | last = Meyer | name-list-style = vanc | url = http://www.hospicepatients.org/and.html | title = Allow Natural Death — An Alternative To DNR? | date = 20 October 2020 | publisher = Hospice Patients Alliance | location = Rockford, Michigan | access-date = 11 April 2008 | archive-date = 20 April 2008 | archive-url = https://web.archive.org/web/20080420074539/http://www.hospicepatients.org/and.html | url-status = usurped }}</ref> Others say AND is ambiguous whether it would allow morphine, antibiotics, hydration or other treatments as part of a natural death.<ref name="sinclair">{{Cite journal |last=Sinclair |first=Christian |date=2009-03-05 |title=Do Not (Attempt) Resuscitation vs. Allow Natural Death |url=https://www.pallimed.org/2009/03/do-not-attempt-resuscitation-vs-allow.html |website=Pallimed.org}}</ref><ref name="youngner">{{Cite journal |last1=Youngner |first1=S. J. |last2=Chen |first2=Y.-Y. |date=2008-12-01 |title="Allow natural death" is not equivalent to "do not resuscitate": a response |url=https://jme.bmj.com/content/34/12/887 |journal=Journal of Medical Ethics |volume=34 |issue=12 |pages=887–888 |doi=10.1136/jme.2008.024570 |pmid=19065754 |s2cid=26867470 |issn=0306-6800}}</ref> New Zealand and Australia, and some hospitals in the UK, use the term ''NFR'' or ''Not For Resuscitation''. Typically these abbreviations are not punctuated, e.g., ''DNR'' rather than ''D.N.R.''

Resuscitation orders, or lack thereof, can also be referred to in the United States as a part of [[Physician Orders for Life-Sustaining Treatment]] (POLST), [[Medical Orders for Life-Sustaining Treatment]] (MOLST), Physician's Orders on Scope of Treatment (POST) or Transportable Physician Orders for Patient Preferences (TPOPP) orders,<ref>{{cite book | vauthors = Pollak AN, Edgerly D, McKenna K, Vitberg DA | collaboration = American Academy of Orthopaedic Surgeons | title = Emergency Care and Transportation of the Sick and Injured | publisher =  Jones & Bartlett Learning | date = 2017 | isbn = 978-1-284-10690-9 | page = 540 }}</ref> typically created with input from next of kin when the patient or client is not able to communicate their wishes.

Another synonymous term is "''not to be resuscitated''" (''NTBR'').<ref>{{cite journal | vauthors = Vincent JL, Van Vooren JP | title = [NTBR (Not to Be Resuscitated) in 10 questions] | journal = Revue Médicale de Bruxelles | volume = 23 | issue = 6 | pages = 497–9 | date = December 2002 | pmid = 12584945 }}</ref>

In 2004 the internal telephone number for cardiac arrests in all UK hospitals was standardised to ''2222'';<ref>{{Cite web |title="Establishing a standard crash call telephone number in hospitals" |url=https://webarchive.nationalarchives.gov.uk/ukgwa/20171030131004/http://www.nrls.npsa.nhs.uk/resources/type/alerts/?entryid45=59789&p=4 |access-date=2021-09-15 |website=webarchive.nationalarchives.gov.uk}}</ref> in 2017 the European Board of Anaesthesiology (EBA, European Resuscitation Council (ERC), and the European Society of Anaesthesiology (ESAIC) issued a joint statement recommending this practice across all European hospitals.<ref>{{Cite web |last=Uniweb |first=Tibo C. |title=ERC {{!}} Bringing resuscitation to the world |url=https://www.erc.edu/projects/2222 |access-date=2023-01-29 |website=www.erc.edu |language=en}}</ref> Current UK practice is for resuscitation recommendations to be standalone orders (such as DNACPR) or embedded within broader emergency care and treatment plans (ECTPs), such as the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT).<ref name="RCUK Patients" />