Do Not Resuscitate Order Chile (Directiva No Reanimar)

Directiva No Reanimar Chile (DNR) is a specific healthcare directive governed by Article 16 of Ley N° 20.584 — the Ley sobre Derechos y Deberes que tienen las Personas en Relación con Acciones Vinculadas a su Atención en Salud, enacted on 24 April 2012 — that instructs physicians (médicos tratantes), nurses (enfermeros/as), paramedics (paramédicos del SAMU — Servicio de Atención Médica de Urgencia), and all healthcare personnel not to initiate or continue cardiopulmonary resuscitation (resucitación cardiopulmonar — RCP) in the event of cardiac arrest (paro cardíaco) or respiratory arrest (paro respiratorio). The directive reflects the patient's exercise of the right to reject extraordinary life-sustaining interventions and to receive a dignified death (muerte digna) consistent with their personal values.

Article 16 of Ley N° 20.584 expressly permits any person with full legal capacity to refuse, in advance or at the time of treatment, extraordinary or disproportionate measures aimed solely at prolonging biological life in the absence of reasonable expectation of recovery. Cardiopulmonary resuscitation in the context of terminal illness, advanced dementia, permanent vegetative state, or end-stage organ failure constitutes such a disproportionate measure (medida desproporcionada) under the clinical guidelines issued by MINSAL and the Colegio Médico de Chile.

In the clinical setting, a DNR directive is operationalized as an orden de no reanimar (medical order) entered by the attending physician in the ficha clínica (medical record) of the patient, consistent with the patient's advance directive. The medical order is binding on all healthcare staff within the same establishment. MINSAL's Guías Clínicas de Cuidados Paliativos and the Norma Técnica de Cuidados Paliativos issued under DS N° 6 de 2007 (MINSAL) guide implementation in hospitals, clínicas, and centros de cuidados paliativos across Chile.

The DNR directive does not constitute euthanasia (eutanasia activa) — a distinction explicitly recognized by the Tribunal Constitucional de Chile in Sentencia Rol N° 2.867-15-INA and affirmed by the Colegio Médico de Chile. Euthanasia involves actively causing death; a DNR directive involves withholding a specific intervention (RCP) and allowing natural death (muerte natural) to occur. All other forms of comfort care, palliative sedation (sedación paliativa), pain management (manejo del dolor), and dignity-preserving care continue under the directive.

Private healthcare establishments (clínicas privadas) accredited by the Superintendencia de Salud, public hospitals within the Red Asistencial del SNSS, and emergency services such as SAMU and Bomberos de Chile are all subject to Ley N° 20.584 and must respect a valid DNR directive. Violation of the directive — performing RCP on a patient with a valid DNR directive — may constitute a violation of the patient's autonomy rights under Ley N° 20.584 Art. 14, subject to complaint before the Superintendencia de Salud or the Juzgado de Letras en lo Civil.

A DNR directive in Chile is appropriate whenever a patient or their healthcare representative determines that cardiopulmonary resuscitation would not align with the patient's values, clinical prognosis, or wishes for end-of-life care.

Patients with confirmed terminal diagnoses — stage IV cancer (cáncer etapa IV), end-stage heart failure (insuficiencia cardíaca terminal), advanced COPD (EPOC avanzado), end-stage renal disease (insuficiencia renal crónica terminal) undergoing palliative management — should discuss and execute a DNR directive with their oncologist, cardiologist, or specialist within FONASA or ISAPRE-contracted facilities. The MINSAL Programa Nacional de Cuidados Paliativos and the Unidades de Cuidados Paliativos in major Chilean hospitals (Hospital del Salvador, Hospital Padre Hurtado, Hospital San José) support patients and families in making these decisions.

Patients in a permanent vegetative state (estado vegetativo permanente) or with severe irreversible brain damage as documented by neurologists at MINSAL-certified neurology centers should have a DNR directive in place to prevent RCP that would serve no therapeutic purpose (futilidad terapéutica) but could cause additional physical trauma.

Elderly residents of nursing homes (residencias para adultos mayores, ancianos) regulated by SENAMA (Servicio Nacional del Adulto Mayor) and the Superintendencia de Salud should be offered the opportunity to execute DNR directives as part of their admission process, in compliance with Ley N° 20.584 and MINSAL guidelines on palliative care in long-term care settings.

Family members acting as legal healthcare representatives under a valid mandato de cuidados médicos may execute or confirm a DNR directive on behalf of a currently incapacitated patient, provided this is consistent with the patient's previously documented wishes or demonstrably consistent with their values and best interests under Ley N° 20.584 Art. 16.

Persons with deeply held religious or philosophical convictions — including members of evangelical Christian communities, traditional Catholic communities, and indigenous peoples (comunidades mapuche, aymara, rapanui) in Chile who believe in natural death without artificial intervention — may execute DNR directives to ensure their spiritual values are respected at the end of life, consistent with the intercultural health approach (salud intercultural) promoted by MINSAL's Programa de Salud Intercultural.

A valid DNR directive under Article 16 of Ley N° 20.584 must contain the following essential elements to be recognized and respected by healthcare providers within Chile's public and private health system:

Patient Full Identity: Full legal name, RUT, date of birth, and domicile of the patient (or healthcare representative executing on the patient's behalf). The patient must be a legally competent adult (mayor de edad con plena capacidad legal), or the document must be executed by a duly authorized mandatario de cuidados médicos for an incapacitated patient.

Clinical Context and Diagnosis: A brief statement of the patient's clinical situation — the terminal diagnosis, chronic condition, or clinical circumstance that makes the DNR directive appropriate. This contextualizes the directive for treating teams and helps prevent the directive from being applied in inappropriate circumstances (such as an accidental emergency in an otherwise healthy person who has an unrelated DNR on file).

Specific Refusal of RCP: An express, unambiguous statement refusing cardiopulmonary resuscitation (RCP) — including chest compressions (compresiones torácicas), electric defibrillation (desfibrilación eléctrica), cardiac medications administered during a code (adrenalina, amiodarona, atropina in a código de paro), endotracheal intubation specifically for resuscitation, and ACLS (Advanced Cardiac Life Support) protocols administered by SAMU teams. The directive should specify whether the refusal applies both in-hospital and in the home or care facility setting.

Scope of Care That Continues: A clear statement of the care that DOES continue — palliative care (cuidados paliativos), pain management (manejo del dolor y los síntomas), comfort measures (medidas de confort), sedation for distress (sedación paliativa), oxygen for comfort, and emotional and spiritual support. This prevents the DNR from being misinterpreted as a general withdrawal of all care.

Setting and Scope: Whether the directive applies: (a) During hospitalization in any hospital or clínica within the Red Asistencial del SNSS or ISAPRE-contracted facilities; (b) In the patient's home (domicilio) or nursing home (residencia de adultos mayores); (c) During transport by SAMU or other emergency services; (d) In all settings without limitation. The SAMU dispatch centers in the Servicio de Salud Metropolitano Central, Oriente, Occidente, Norte, and Sur require a physical copy of the directive to be accessible to emergency responders.

Healthcare Representative Contact: Name, RUT, and contact details of the healthcare representative (mandatario or designated family member) who can be reached to confirm the directive in an emergency situation. The representative should carry a copy of the DNR directive and the underlying mandato de cuidados médicos.

Treating Physician Acknowledgment: Where possible, signature or written acknowledgment of the treating physician (médico tratante) who has discussed the directive with the patient and will enter the corresponding orden de no reanimar in the ficha clínica. The Colegio Médico de Chile's clinical ethics guidelines require physicians to document this discussion.

Notarial Authentication: Execution before a notario público or, for patients who lack capacity to attend a notary office, a notary who visits the patient (notario que concurre al domicilio del paciente). The notarial instrument creates full evidentiary force before all Chilean healthcare authorities.

Distribution of Copies: The original directive should be given to: the patient (or their mandatario); the primary care physician (médico de cabecera); the hospital or care facility where the patient receives treatment; MINSAL's Registro Nacional de Voluntades Anticipadas; and FONASA or the relevant ISAPRE for the patient's health coverage record.

Forms-legal.com provides this DNR directive template for Chilean patients and families navigating end-of-life care decisions. Given the profound nature of this decision, patients and families are encouraged to discuss DNR directives with their médico tratante and with a specialist in palliative care (cuidados paliativos) before execution.