Estate Planning: DNR Orders
A DNR order, or a do-not-resuscitate order, is a pre-written healthcare directive made by a patient concerning life-saving medical interventions. As the name implies, DNRs tell doctors not to resuscitate the patient in certain circumstances – usually if the heart stops.
What is Resuscitation?
Resuscitation is treatment given when a person's blood flow or breathing stops. Doctors and physicians have several ways of resuscitating patients, the most common of which include:
- Cardiopulmonary resuscitation (CPR), which involves mouth-to-mouth breathing and pressing on the chest
- Advanced cardiac life support (ACLS)
- Defibrillation
- Assisted breathing machines, like a ventilator
- Medicines
In some cases, these resuscitation methods save the patient from death but leave them in poor condition. People who want to avoid the latter outcome can create and sign a Do-Not-Resuscitate order, preventing doctors from resuscitating under certain or any circumstances.
How DNRs Work?
A DNR is a legally-binding, dated order, written and signed by your physician with the patient's name. The doctor can only write a DNR order after consulting with you (the patient), your appointed representative, or a member of your family. The order, once executed, instructs medical providers to refrain from resuscitating the named patient. Each state varies somewhat with specifics about the DNR order. For example, some DNRs expire over a certain period of time while others remain indefinitely.
Like an advance directive or a living will, DNRs allow you to express your preferences regarding end-of-life care. Unlike these other forms of healthcare directives, though, DNRs are very straightforward: they tell doctors not to resuscitate the patient. CPR and other forms of resuscitation are automatically performed to save a person's life in the absence of an appropriate DNR order.
A DNR order can be a stand-alone document, or it can be a smaller part of an advanced directive. An advanced directive is a collection of all legal orders surrounding a patient's medical care, like health care proxies and living wills.
Can Anything Override a DNR Order?
Once a doctor writes a DNR order upon your request, no one can override it––including family members. If you change your mind about the DNR, however, you can always speak to your doctor and have it revoked.
Things to Consider Prior to Signing a DNR
There are a few things to consider prior to signing a DNR. Here's a short list.
- Do you have any religious, ethical, or moral beliefs opposed to resuscitation? Some religions oppose resuscitation methods while some people are simply opposed to the idea on moral or ethical grounds.
- Why do you not want to be resuscitated? Are you seriously ill or have you been diagnosed with a terminal illness? Sometimes a person who is not terminally ill may want a DNR order if their health generally is deteriorating.
- Do the side effects worry you? Side effects can be serious even if resuscitation is successful. If chest compressions were used, you could end up with broken ribs, punctured lungs, or a damaged heart. For an older person, these physical injuries are significant.
- Do survival rates concern you? People over the age of 70 who are revived through resuscitation often do not have good survival rates. Though statistics vary, for most elderly persons, outcomes can be depressing, and so for some, it feels like they are prolonging the inevitable. It is important to keep in mind, though, each person is different, and you could have a good prognosis even when the statistics indicate otherwise.