DNR in the Netherlands: penning, document, tattoo
If your heart stops in a Dutch street, an ambulance crew will start resuscitation within seconds. They are trained to act on the assumption that you want to be revived, unless they can see, immediately, that you do not. That last word — see — is what makes the difference between a wish and an instruction the ambulance can follow.
This explainer covers the three ways that a do-not-resuscitate decision is made visible in the Netherlands: the niet-reanimerenpenning (medallion), the written wilsverklaring, and the tattoo. What is legally valid, where to obtain each, and when responders act on it.
What "DNR" means here
In Dutch healthcare, a niet-reanimeren-besluit (do-not-resuscitate decision) is a request not to be resuscitated in the event of cardiac or respiratory arrest. It is not a decision to refuse other care. It does not mean palliative or comfort treatments will be withheld. It applies to one specific intervention — cardiopulmonary resuscitation (CPR) — at one specific moment.
The decision can be made by the patient (in advance or in the moment, if able) or, in some clinical situations, by the treating doctor on medical grounds. This explainer covers the patient-driven version: how a healthy or chronically ill person makes their own DNR wish operationally enforceable in the Netherlands.
The penning: the most reliable instruction in an emergency
The niet-reanimerenpenning is a small metal medallion worn on a chain around the neck. Its purpose is single and practical: to be visible the moment a paramedic opens your shirt to start CPR.
The penning carries the wearer's name, date of birth, signature, photo and the explicit text "Ik wil niet gereanimeerd worden" (I do not wish to be resuscitated). Since 1 January 2025, the penning is issued by the NVVE (Nederlandse Vereniging voor een Vrijwillig Levenseinde). It was previously distributed by the Patiëntenfederatie Nederland, whose government subsidy for it ended at the end of 2024. To obtain one, you send the NVVE an order form with your signature and a passport photo. The cost is €55 for non-members and €40 for NVVE members.
In the standard Dutch ambulance protocol, a clearly visible niet-reanimerenpenning is treated as a binding refusal of CPR. The ambulance crew checks the photo against the patient's face and, if there is no doubt, withholds resuscitation. There is no need for relatives to be present or to confirm the wish.
The penning has limits. It must be visible — under clothing, jewellery or a coat, it may not be seen in time. It only refuses CPR; for broader treatment refusals, a separate document is needed. And if there is genuine doubt about identity, the crew may begin resuscitation while it is resolved.
The wilsverklaring: the document behind the wish
A behandelverbod (treatment refusal) within a wilsverklaring (advance directive) is the written form of the same wish, often broader. It can refuse not only CPR but also, for example, mechanical ventilation, tube feeding, or further hospitalisation in defined circumstances. Templates are published by the NVVE and can be drafted with the help of the huisarts (general practitioner) or a notaris (notary).
For the document to function in practice, two things matter: it should be discussed with the huisarts and kept in the patient's medical file, and the family — particularly the gevolmachtigde (designated representative) — must know where it is kept. A wilsverklaring in a drawer that no one can find at the moment of need is, operationally, no instruction at all.
In the home setting, where the huisarts knows the patient, a written behandelverbod is generally honoured. In an out-of-home emergency where the ambulance crew has no time to read papers, the document on its own is less reliable than the penning. The two are complementary: the penning for the seconds, the wilsverklaring for the longer decisions that follow.
The tattoo: valid, but only if it is seen
In recent years, "Niet reanimeren" tattoos have become a topic of public discussion in the Netherlands and elsewhere. They are visible, permanent, and require nothing to be carried.
In the Netherlands, a clearly legible "Niet reanimeren" tattoo on the chest is legally valid as a refusal of resuscitation. The catch is practical: responders don't search for it, so it only works if it is seen. Since October 2025, lay responders (burgerhulpverleners), police and firefighters also stop CPR when they see a penning or a tattoo.
Children and minors
For children, decisions about resuscitation are made by parents or guardians together with the treating doctor, recorded in the medical file, and discussed with the school, hospice or care setting where relevant.
When the ambulance respects which
In short:
- Penning, clearly visible, photo matches, no doubt: the ambulance withholds CPR.
- Wilsverklaring with behandelverbod, in the medical file, known to the huisarts: respected at home and in planned care; less reliable in an unannounced emergency.
- Tattoo, clearly legible "Niet reanimeren" on the chest: valid, but only if the crew sees it.
For maximum reliability, the recommendation from the NVVE is a combination: a penning on the body for emergencies, a wilsverklaring on file for the rest of care, and a conversation with the huisarts that ties the two together.
In the app
In the Personal Portal, in Legal Papers, you record whether you carry a niet-reanimerenpenning and have a niet-reanimerenverklaring or behandelverbod, the date your wilsverklaring was discussed with your huisarts, and where the original document is kept. The app does not draft these documents. You fill it in at your own pace, and what you record becomes part of your Zorgmap, a PDF you print or hand to your gevolmachtigde and the other people you trust, so the right person can answer when asked.
Closed beta — access by invitation.
Sources
- NVVE — Nederlandse Vereniging voor een Vrijwillig Levenseinde, issuer of the niet-reanimerenpenning since 1 January 2025; wilsverklaring templates, guidance on behandelverbod, and the validity of a niet-reanimeren tattoo. https://www.nvve.nl
- Nederlandse Reanimatieraad — guidance on niet-reanimerenverklaringen for responders. https://www.reanimatieraad.nl
- KNMG — Royal Dutch Medical Association, professional guidance on niet-reanimerenbesluiten. https://www.knmg.nl
- Patiëntenfederatie Nederland — issuer of the niet-reanimerenpenning until the end of 2024. https://www.patientenfederatie.nl