In certain situations, Do Not Resuscitate Orders (DNR) can be issued by surrogate health care decision makers for minors or adult patients who are incompetent or otherwise mentally or physically incapable of communicating. The specific requirements of DNRs will vary by state. Generally, appropriate legal guardians or medical care providers have the authority to decide whether to withhold or withdraw life-sustaining treatment.

Who Is an Authorized Surrogate?

Depending on the individual patient and the particular circumstances, states recognize the following as authorized surrogates:

In the absence of any of the above surrogates, health care providers, such as doctors, may also be able to act as surrogate decision makers.

Who Decides When There Are Multiple Authorized Surrogates?

If there are multiple surrogate parties, conflicts can arise as to whose authority takes precedence. If the parties do not agree on the appropriate course of action, then they may resort to the court to make the determination. Establishing a do not resuscitate order in advance or identifying and empowering a single surrogate party in cases of minors or incapacitated adults can help prevent such conflicts.

When Is It Appropriate for a Surrogate to Order a DNR?

If the court system is used to determine the appropriateness of issuing a DNR Order by Surrogate, two main standards will likely be applied:

  • Substituted Judgment standard: The Substituted Judgment standard is primarily used in cases of adults who have been incapacitated and cannot communicate their wishes. In applying this standard, the decision maker must determine as much as possible the decision the patient would have likely made
  • Best Interests standard: The Best Interests standard is more often used in cases of infants and minors whose judgment would not likely be used but instead whose best interest must be determined by the surrogate decision maker.

Should I Contact a Lawyer?

If you have concerns about surrogate DNR decisions, it is essential to get a good will lawyer to help secure your rights, and if necessary, persuade the court what the right arrangement is for the patient.