A valid Do Not Resuscitate order in New Jersey has to meet a short list of New Jersey DNR order requirements: it must be a written order signed by your attending physician and entered in your medical record, it must be authorized either by you (if you have decision-making capacity) or by a legally recognized surrogate (if you do not), and if you want it honored outside a hospital, it has to appear on the standardized Out-of-Hospital DNR form or through a state-recognized DNR bracelet or necklace that EMS crews are trained to identify.
Who Can Authorize the Order
Under N.J.S.A. 26:2H-68, the attending physician issues the DNR order consistent with the patient’s advance directive, and the order must be entered in writing in the medical record before it takes effect.1Justia. New Jersey Code 26-2H-68 – Issuance of Do Not Resuscitate Order The statute also preserves any existing legal authority to issue a DNR when a patient has not executed an advance directive, so physicians are not boxed into acting only where a written directive already exists.
If you have decision-making capacity, you authorize the DNR yourself. If you don’t, a surrogate steps in. The cleanest way to designate one in advance is a proxy directive naming a healthcare representative to make medical decisions on your behalf.2Justia. New Jersey Code 26-2H-53 – Short Title Without one, New Jersey falls back on a statutory hierarchy that typically starts with a spouse or domestic partner, then adult children, parents, and other close relatives. If no family member is available, a court can appoint a guardian.
How Capacity Gets Determined
Because a DNR turns on your ability to understand what you are agreeing to, the law builds in a specific capacity process. The attending physician makes the initial determination in writing, including an opinion on the nature, cause, extent, and likely duration of any incapacity.3Justia. New Jersey Code 26-2H-60 – Determination of Lack of Decision Making Capacity At least one additional physician must then confirm that finding in writing, and that confirming opinion also goes in the record.
Confirmation can be skipped only when the lack of capacity is clearly apparent and both the attending physician and the healthcare representative agree it is unnecessary. If the incapacity stems from a mental or psychological condition or a developmental disability, and neither the attending nor the confirming physician has specialized training in that area, a physician with the right expertise has to provide the confirmation.
The standard is functional, not diagnostic. The question is whether you can understand the nature and consequences of the specific decision at hand, including benefits, risks, and alternatives, and whether you can reach an informed decision based on that understanding. A physician named in your advance directive as your healthcare representative cannot be the one making or confirming the capacity determination.
What the Written Order Must Contain
The order has to be in writing and placed in your medical record before anyone acts on it.1Justia. New Jersey Code 26-2H-68 – Issuance of Do Not Resuscitate Order In a hospital or nursing home, that is handled through the chart, and staff are notified through normal channels. Outside those settings, you have to do more deliberate work, because EMS crews arriving at your home have no chart to look at.
New Jersey uses a standardized Out-of-Hospital DNR form for exactly this reason. The form should include your full name, date of birth, and a clear statement that resuscitation should not be attempted. The attending physician signs and dates it, confirming that you or your authorized surrogate have been informed about what the order means.
For the form to actually work in an emergency, it has to be visible. Keep it prominently placed in your home, or carry it on your person. Many patients also wear a state-recognized DNR bracelet or necklace so first responders can identify the directive immediately, without hunting through paperwork.
If there is any ambiguity about whether a valid DNR exists, EMS defaults to performing CPR. That is deliberate: the system is built to err on the side of resuscitation whenever documentation is missing, unclear, or disputed by someone at the scene.
Revoking the Order
You can revoke a DNR at any time if you have capacity, and an authorized surrogate can revoke it too. New Jersey does not require a formal written process. You can verbally tell a healthcare provider you want the order rescinded, you can cancel or destroy the physical form and any associated identification, or your attending physician or surrogate can direct the revocation.
Verbal revocation works fine in a hospital, where staff can update the chart on the spot. At home, verbal alone is risky. If EMS arrives and finds an out-of-hospital DNR form on the refrigerator or a bracelet on your wrist, that is what they will act on. Destroy the form and remove the bracelet or necklace. Tell your primary care physician so the change flows through the rest of your records.
What a DNR Does Not Cover
A DNR answers one question: should CPR be performed if your heart stops or you stop breathing? It does not speak to ventilators, antibiotics, feeding tubes, or any other treatment. If you want control over those decisions, you need a separate document.
An instruction directive, often called a living will, lets you spell out preferences for a range of medical treatments if you cannot communicate. It covers broader territory than a DNR, but it does not require a physician’s signature and functions more as guidance for future decisions than as an immediately actionable order.
A POLST form, governed by the Practitioner Orders for Life-Sustaining Treatment Act, is closer to a DNR but broader.4Justia. New Jersey Code 26-2H-129 – Short Title A POLST contains signed medical orders covering multiple interventions, such as intubation, artificially provided fluids, and the overall intensity of treatment you want.5New Jersey Legislature. New Jersey PL 2019 c218 – Practitioner Orders for Life-Sustaining Treatment Act You (or your surrogate) and a healthcare practitioner both sign it, and it is binding across healthcare settings, following you from home to hospital to nursing facility.6Legal Information Institute. New Jersey Administrative Code 8-42-6.4 – Practitioner Orders for Life-Sustaining Treatment (POLST)
If You Have Surgery Scheduled
One situation that catches patients off guard: what happens to your DNR when you go in for surgery. Cardiac arrest during anesthesia is a different clinical event from arrest caused by terminal illness, and national medical organizations have moved away from blanket policies that automatically suspend DNR orders in the operating room. The American Society of Anesthesiologists and the American College of Surgeons both recommend a case-by-case conversation before any procedure.
Three protocols have emerged from that guidance:
- Full suspension, where you or your surrogate agree to temporarily lift the DNR during surgery and a defined recovery period, allowing the team to use any resuscitation measures they consider appropriate.
- Limited resuscitation by procedure, where you accept some interventions and refuse others after the anesthesiologist explains which ones are essential to the planned anesthesia method.
- Goal-directed resuscitation, where you describe your values and goals and let the surgical team use clinical judgment about which interventions align with them during the procedure.
If you have a DNR and surgery is coming up, expect the anesthesiologist or surgeon to raise this conversation beforehand. If they don’t, raise it yourself. Skipping it leaves the surgical team guessing at the worst possible moment.
Directives From Another State
New Jersey recognizes advance directives that are valid in another state.7State of New Jersey Department of Health. Advance Directive – Forms and FAQs Legal recognition and field recognition are not the same thing. An out-of-state Out-of-Hospital DNR form may not look like the standardized New Jersey version that EMS crews are trained to spot, and a first responder who cannot quickly verify a document’s validity will start CPR.
If you split time between states or travel often, have a New Jersey-specific form completed in addition to whatever directive you already hold. That removes the ambiguity that can override an otherwise valid order in the minutes that matter.