Do Not Resuscitate (DNR) Orders
DNR stands for “Do Not Resuscitate.” A DNR order indicates that a person has decided not to have CPR (cardiopulmonary resuscitation) attempted in the event his or her heart or breathing stops. DNR orders are written by a licensed physician, after discussing the burdens and benefits of CPR with the patient or the patient’s surrogate decision maker.
CPR uses mouth-to-mouth or machine breathing and chest compressions to restore the work of the heart and lungs when a person’s heart or breathing has stopped. In some cases, more advanced CPR interventions are needed.
Here are some cases in which a person may not want CPR attempted:
- When there is no medical benefit expected. CPR wasn’t meant for people who are terminally ill or have severe health problems.
- In instances where quality of life would suffer. Sometimes CPR is only partly successful. Though the patient survives, they may suffer painful injuries during CPR or they might be left in a worse condition than before
- When death is expected soon. Persons with terminal illness may not want aggressive interventions, preferring a natural and peaceful death.
Types of Do Not Resuscitate Orders
A physician and patient often consider a DNR order when the patient is entering a hospital for surgery or other treatment, if the patient is terminally ill, or the patient’s overall physical condition is severely and permanently diminished.
If both the physician and the patient agree that a DNR order is the right decision for the patient, the doctor enters the order into the patient’s medical chart. As long as the patient is in the hospital, the DNR order in the chart must be respected by all medical personnel.
If the patient is not in the hospital, an out-of-hospital DNR order form should be completed by the patient and the physician. This is true even if the patient had a DNR while in the hospital.
Do You Need a DNR?
Unlike an advance directive and health care power of attorney, a DNR order is not a document that everyone needs. Typically, people consider a DNR if they have a terminal illness or are at a high risk of cardiac or respiratory arrest.
Making a decision about resuscitation should be based on a combination of your personal preferences along with the medical facts and treatment options. Have a discussion with your physician and other trusted health care providers. Ask your physician for recommendations based on your situation. And think about what is important to you and your family. Some people find it helpful to get counseling from clergy, therapists, or social workers.
You always have the right to change your mind after a DNR order is written. To change DNR orders, talk to your physician. Because the DNR order is your physician’s order, your physician must be involved to change it. Destroy all DNR forms and identification that you were given or are wearing, and inform your family and other caregivers of the change in your decision.
What To Do with a DNR Form
Outside of the hospital, a DNR order won’t do any good if emergency responders don’t know about it. To ensure that emergency medical personnel see your DNR order:
- Post a copy on the inside of your front door, on your refrigerator, in the bathroom, or in other prominent places around your home.
- Consider wearing identification, such as a necklace or bracelet that indicates that a DNR order is in place. It alerts emergency medical personnel to look for your posted form.
You have the right to accept or refuse medical treatments. Discuss your options and your wishes with your physician, other health care providers, and your family.
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