Do-Not-Resuscitate (DNR) orders fall under the category of advance directives for health care. DNR orders are a written order from your doctor. A DNR order represents a deliberate decision to withhold life-saving measures, such as cardiopulmonary resuscitation, if your cardiac or respiratory function ceases.
One reason such a decision might be made is if prolonging the person’s life would bring no benefit to you and offer no future quality of life. Advocates believe that in some cases of inevitable death, resuscitation denies a patient the right to choose a comfortable and peaceful death.
A decision to forgo resuscitation is a decision best made by you, allowing you to express your own wishes about care and treatment options in the event of incapacitation. Discussions about DNR orders are difficult to have and too often occur only after a patient is very ill. Making plans in advance allows you to express desires while capable of doing so with a clear mind and prevents placing the responsibility on family or health care providers to guess what your desires might be.
DNR orders do not mean that you will be denied care. In fact, there are many measures that can be taken to help a dying patient be comfortable. With an overall goal of your comfort and family support as the top priority, care efforts are refocused on you and your physical, psychological and spiritual needs. Hospitals offer liberalized visiting hours, educational materials, counseling, and specialized care plans for medical treatment. Hospital care goals for terminally ill patients include:
1. Providing meticulous care, including keeping you clean, dry, and comfortable;
2. Offering family members a place to rest and encouraging them to take care of themselves;
3. Offering referrals to local hospice providers for bereavement counseling;
4. Seeking physician support to discontinue invasive monitoring, nasogastric tubes, laboratory testing, central venous catheters and offering medication and sedation to provide comfort.
In making a decision about care at the end of your life, there are of course many things to consider. Here are points to think about that might help you begin the process of deciding about a DNR preference:
1. Can you make a decision earlier rather than later? If so, have your DNR preference recorded in your medical record. You can revise your wishes at any time.
2. Think about and express your spiritual wishes and any special care provisions you would like at the end of life. Where will you record your preferences? How will you share them with your family or loved ones?
3. If CPR is initiated and is only partially successful, how do you feel about being placed on a respirator or other life sustaining equipment?
4. Do you understand about hospice and palliative care? Does your preferred hospital have a palliative care policy? Hospitals that have a palliative care committee or special unit may be best able to meet your needs. A local hospice can explain its service and help you to understand what services they offer for you and your family.
5. Do you have anyone with whom you can discuss your preferences? Perhaps it will be easier to discuss these difficult topics with a good friend?
A DNR decision must be documented in your medical record and signed by your doctor. In a hospital or emergency care situation, if a DNR order is not in place, health care providers are obligated to initiate life-saving measures. Also, in some states, if a 9-1-1 call is placed on your behalf, emergency personnel will perform CPR, even if you have a DNR in place. That is why hospice providers will advise you and your family not to call 9-1-1 if your heart or breathing stops. In states that have provisions for out-of-hospital DNR orders, your doctor must sign the order and you must post it in your home or wear a special DNR bracelet. Your doctor, a local hospice or the health department can tell you if your state allows out-of-hospital DNR orders.
Your medical provider can supply you with the necessary paperwork and instructions to initiate a DNR. In all cases, if you decide to ask your doctor to record a DNR order in your medical record, you must be sure that your family and all of your care providers know about it.
