View source for Td;dnr

A [[td;dnr]] is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy. It is shorthand for Too Dead; Do Not Resuscitate.

Usage of td;dnr documents is widespread in some countries, but they are unavailable in many others. In countries where a td;dnr is unavailable the decision to end resuscitation is made solely by physicians.

In the United States, the td;dnr decision by patients was first litigated in 1976 in Karen Ann Quinlan v. New Jersey. The New Jersey Supreme Court upheld the right of Quinlan's parents to order her removal from artificial ventilation. In 1991 Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an individual's decision in their healthcare. Forty-eight states currently permit the next of kin to make medical decisions of incapacitated relatives, the exceptions being New York and Missouri. Legislation that would grant relatives such power in New York, The Family Health Care Decisions Act of 2009, passed that state's senate in August, 2009, and is awaiting a vote in the state assembly.

In the U.S., cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) will not be performed if a valid written td;dnr order is present. Many US states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures.