[10] When medical institutions explain DNR, they describe survival from CPR, in order to address patients' concerns about outcomes.

[23] Two Dartmouth College doctors note that "In the 1990s ... 'resuscitation' increasingly began to appear in the medical literature to describe strategies to treat people with reversible conditions, such as IV fluids for shock from bleeding or infection... the meaning of DNR became ever more confusing to health-care providers.

[44] Hospital doctors do not agree which treatments to withhold from DNR patients, and document decisions in the chart only half the time.

The hospitals putting fewest patients on DNR had more successful survival rates, which the researchers suggest shows their better care in general.

[6] In 2017, Critical Care Medicine (Ethics) and the American Society of Anesthesiologists (ASA) Committees on Transplant Anesthesia issued a statement regarding organ donation after circulatory death (DCD).

The definition of irreversibility centers around an obligatory period of observation to determine that respiration and circulation have ceased and will not resume spontaneously.

Clinical examination alone may be sufficient to determine irreversibility, but the urgent time constraints of CDC may require more definitive proof of cessation with confirmatory tests, such as intra-arterial monitoring or Doppler studies.

[48] Most patients considered for DCD will have been in the intensive care unit (ICU) and are dependent on ventilatory and circulatory support.

[46] The philosophical factors and preferences mentioned by patients and doctors are treated in the medical literature as strong guidelines for care, including DNR or CPR.

Physician Orders for Life-Sustaining Treatment (POLST) documents are the usual place where a DNR is recorded outside hospitals.

A disability rights group criticizes the process, saying doctors are trained to offer very limited scenarios with no alternative treatments, and steer patients toward DNR.

[58] Medical bracelets, medallions, and wallet cards from approved providers allow for identification of DNR patients in home or non-hospital settings.

[59] End of life (EOL) care preferences are dynamic and depend on factors such as health status, age, prognosis, healthcare access, and medical advancements.

[66][67][56][68] It is possible that providers are having a "leading conversation" with patients or mistakenly leaving crucial information out when discussing DNR.

[71] A self-report study from 1999 conducted in Germany and Sweden found that the frequency of resuscitations performed against patients' wishes (per DNR status) was as high as 32.5% among German doctors polled.

[74] Physicians and their attorneys have argued in some cases that when in doubt, they often err on the side of life-saving measures because they can be potentially reversed later by disconnecting the ventilator.

[83] 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.

The legality of not administering resuscitation procedures for terminally ill patients has not been clearly defined, leading many providers to practice caution around withholding CPR.

[95] Although DNR orders have not been institutionalized in Brazil there has been a significant amount of dialogue around the ethical question of whether or not to withhold resuscitation interventions.

A recent study also showed that in Brazil's healthcare system CPR is being withheld in scenarios of terminal illness or multiple comorbidities at rates similar to those in North America.

Secondly, it empowers the right to palliative care that may also include the intensification of the doses of certain medications that can result in the shortening the patient's life span.

[99] The Hong Kong Hospital Authority has adopted a set of forms which its doctors will recognize if properly completed.

[100][101] In Israel, it is possible to sign a DNR form as long as the patient is at least 17 years of age, dying, and aware of their actions.

The law no.219 "Rules on informed consent and advance treatment provisions", reaffirm the freedom of choice of the individual and make concrete the right to health protection, respecting the dignity of the person and the quality of life.

The DAT are the provisions that every person of age and capable of understanding and wanting can express regarding the acceptance or rejection of certain diagnostic tests or therapeutic choices and individual health treatments, in anticipation of a possible future inability to self-determine.

Patients may also specify their wishes and/or devolve their decision-making to a proxy using an advance directive, which are commonly referred to as 'Living Wills', or an emergency care and treatment plan (ECTP), such as ReSPECT.

Evaluation of ReSPECT (an ECTP) found that resuscitation status remained a central component of conversations, and that there was variability in the discussion of other emergency treatments.

Patients and families cannot demand CPR to be performed if it is felt to be futile (as with any medical treatment) and a DNACPR can be issued despite disagreement, although it is good practice to involve all parties in the discussion.

The New Jersey Supreme Court upheld the right of Karen Ann Quinlan's parents to order her removal from artificial ventilation.

In the United States, cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) will not be performed if a valid written DNR order is present.