Deciding whether or not you may want a Do Not Resuscitate (DNR) order is an important part of end-of-life planning. It can be included in a living will or be part of your advance healthcare directive. It is up to you if you want a DNR order, but there are a few things you should know first.
For instance, you could have a written DNR that is not followed because emergency services are called or because your medical provider was not informed. You could have a DNR that does not apply to your circumstances (even if you might have thought that it would).
What does it do and when does it apply? Let’s walk through the basics.
What is a DNR?
A DNR order is a legal document with instructions to your hospital and/or medical provider that you are not to be revived with cardiopulmonary resuscitation (CPR,) or shock equipment if you go into cardiac arrest. Some hospitals call it DNAR (do not attempt resuscitation) or AND (allow natural death) instead of DNR.
People who consider getting a DNR order typically suffer from a terminal illness or are otherwise at risk for cardiac or respiratory arrest.
If you have a DNR order, it should be signed by your physician and all your attending medical personnel should be made aware of it. If you are transferred to a new facility, the new facility should also be made aware of the order.
Does it work?
Even if you have a DNR, that is no guarantee that you will not be resuscitated. If you go into cardiac arrest and someone calls emergency services, they generally will not have time to check if there is a DNR order, they will just get to work.
If you want the DNR to be honored, consider displaying it where first responders might find you, and make sure your family and primary care physician have a copy. You may also want to tell your family or caretaker not to call emergency services if your heart stops or you stop breathing. Make sure that if you have appointed someone as your medical power of attorney, that they have a copy of the order.
If you are at a hospital, and you are transferred to a new facility, the new health care providers need to have a copy of your DNR order as well.
In some states, the order can expire after a certain amount of time, so check periodically to see if your DNR order is up-to-date.
It may also be helpful to get a bracelet or other medical jewelry that informs first responders of your DNR order. There are companies that you can order medical jewelry from that will keep a copy of your DNR order on file.
Medical providers are not required to follow a DNR order they do not know about. The important part is making sure that your medical providers know about it.
Does a DNR mean that you are no longer receiving medical treatment?
No, not at all. A DNR order only applies to efforts to bring you back with CPR or shock treatments if go into cardiac arrest. It has no impact on any other treatments you may be undergoing, medications, pain management, etc. You can still get surgery and other procedures even if you have a DNR order.
Essentially, a DNR does not mean “do not treat.” It means exactly what it says: “do not resuscitate.”
What if I have other opinions about end-of-life medical treatment?
If you would like to provide further instructions to your medical team about your preferences with regards to end-of-life treatments, you may want to consider an advance medical directive, durable power of attorney, or another form called a POLST (Physician Orders for Life-Sustaining Treatment).
A POLST (sometimes called a different name in different states, like MOLST, MOST, POST, TPOPP) combines a DNR with an advance medical directive in order to provide your medical team with specific instructions about your end-of-life treatments.
In some states, medical providers are required to offer a POLST if you are terminally ill with a life expectancy of less than 5 more years.
A POLST can include instructions on whether or not you want a ventilator, use of antibiotics, pain management, feeding tube, etc.
How do I decide if I need a DNR order?
If you are faced with a terminal illness or at high risk for heart failure, then you may want to discuss a DNR order with your doctor. They will be able to talk to you about the chances of CPR being successful if you go into cardiac arrest, and what the impact might be on you and your health if you stop breathing or your heart stops beating and are subsequently revived.
Make sure you have all the information you need before making this difficult choice about what will be best for you.
When is the right time to get a DNR?
Having a DNR order — along with a living will — is not a light decision and is not for everyone. For patients who are terminally ill, if they go into cardiac arrest, many of them will not be able to be resuscitated because of their weakened state. If they are resuscitated, their quality of life may be poor. They may suffer from brain damage as a result of the temporary loss of blood to the brain, and may not be able to survive on their own without a respirator.
If you are terminally ill, and have just a few years to live, or you are near the end of your life and know that you are at high risk for cardiac arrest, then you may want to consider a DNR.
It is important to get it taken care of while are mentally competent—if you wait, and are no longer able to speak for yourself, then someone else will make the decision for you, and it may not be what you would have preferred.