As a loved one ages, they will likely begin thinking about the type of medical treatment they would like to receive if they fall ill or need end of life care. While many choose to pursue a do not resuscitate order (DNR), family members who are unfamiliar with what that really means may feel worried. DNRs, however, allow people to maintain control of their medical care and retain a sense of dignity before they are unable to clearly state their wishes. This guide can help families become more familiar with the many intricacies of DNRs if their loved one requests it.
Do Not Resuscitate Orders Explained
If your loved one’s heart and/or breathing stops, medical personnel are required to begin CPR. A do not resuscitate order, or DNR, is written by a physician to inform healthcare providers that a patient does not want any attempt to be made to revive them in these instances. To file a DNR, your loved one must fill out a form and have it signed by their physician, who will make the order part of your loved one’s medical record and inform other members of their medical team. The order can be revoked by your loved one or an authorized decision maker at any time.
To be eligible for a DNR, your loved one must discuss it with their doctor while they have the ability to make medical decisions. If they are deemed incapable of doing so, a living will or healthcare agent — such as a trusted family member or person with power of attorney — must be consulted. If your loved one is facing a serious illness or has entered hospice care, make time to speak with them about their wishes while they are coherent and able to make clear decisions.
A do not resuscitate order does not preclude your loved one from receiving other kinds of medical treatment, and all possible measures will be taken to keep them comfortable. They can still be given intravenous fluids, artificial hydration or nutrition, antibiotics, and other medical services after signing a DNR. If your loved one has specific requests regarding other aspects of their medical care, they may want to consider preparing an advance directive, which outlines these wishes.
A DNR will remain in effect if your loved one is transferred between healthcare facilities, though a new one may need to be issued depending on each facility’s policies. It will not, however, apply to surgeries, as cardiac or respiratory arrest can be caused by the procedure and not the underlying illness.
Non-Hospital DNRs
A non-hospital DNR applies to individuals who live at home or in residential care facilities. They must also be signed by physicians and apply to all medical personnel, including emergency medical service providers, but not bystanders who try to help. Non-hospital DNRs should be discussed if your loved one is in hospice care at home. If they are taken to the hospital, the DNR order should be brought with them so that a hospital DNR can be written.
Differences From Do Not Intubate Orders
A do not intubate order, while similar to a do not resuscitate order, means that no breathing tube will be placed to resuscitate your loved one. However, chest compressions and cardiac drugs may be used. This type of advance directive helps your loved one specify exactly what type of care they do or do not want and can be used in conjunction with other directives, such as DNRs.
Concerns With Do Not Resuscitate Orders
There are various advantages and disadvantages of using CPR depending on your loved one’s condition, and it is important to discuss these with their physician. The physician should explain what CPR entails, the definition and probability of a successful resuscitation in your loved one’s specific case, and their likely condition after.
If your loved one or other family members disagree with the physician’s recommendation or the possibility of signing a do not resuscitate order, they may schedule a meeting with the healthcare team to discuss their concerns and get clear information about the pros and cons of signing a DNR. Healthcare facilities are obligated to make conflict resolution services and their policies on DNRs available to assist.
It is important to note that in exceptional cases, such as when a person is incapacitated and an authorized decision maker cannot be reached, a physician may put a DNR in place if they believe CPR would not be appropriate treatment for that person.
Getting More Information
Speak to Harbor Light Hospice for more information about do not resuscitate orders. The hospice care provider can help you understand the way a DNR would apply to your loved one and what to expect if they do or do not choose to sign one. Our team of medical professionals includes doctors, registered nurses, and other specialists who can assist. Harbor Light Hospice also provides spiritual and emotional counseling, which may be helpful in discerning the right course of action.