A Do Not Attempt Resuscitation (DNAR) order is a medical directive that communicates a patient’s wish to decline life-saving interventions in the event of cardiac or respiratory arrest. This order ensures that medical professionals respect an individual’s decision to forgo specific medical procedures if their heart stops beating or they stop breathing. Its purpose is to align medical care with patient preferences at a crucial juncture.
What a DNAR Order Means
A DNAR order directs healthcare providers to withhold certain interventions if a patient experiences cardiac arrest (when the heart stops beating) or respiratory arrest (when breathing ceases). These interventions include chest compressions, artificial ventilation, defibrillation, and emergency medications designed to stimulate heart function or breathing.
A DNAR order does not mean withholding all medical care. Patients with a DNAR order continue to receive other appropriate medical treatments, including comfort care, which focuses on relieving pain and other symptoms, and non-resuscitative treatments such as antibiotics for infections or nutrition. The purpose of a DNAR is to allow a natural death, rather than to choose death itself.
Establishing a DNAR Order
Establishing a DNAR order begins with discussions between the patient and their medical team. These conversations cover the patient’s prognosis, available treatment options, and the potential implications of a DNAR order. Physicians are ethically obligated to describe resuscitation procedures candidly, including the likelihood of medical benefit and the chances of achieving the patient’s desired quality of life.
If the patient has decision-making capacity, their wishes regarding resuscitation are ascertained directly. If the patient lacks this capacity, the discussion involves their legally appointed healthcare surrogate or proxy. In certain specific circumstances, if no surrogate exists, the medical team may consult with the family to determine the patient’s presumed wishes.
Once the decision is made, a DNAR order is signed by a physician and becomes part of the patient’s medical record. While specific laws governing these orders vary by jurisdiction, the legal recognition of DNAR orders ensures that healthcare providers are obligated to respect these documented patient decisions.
DNAR vs. Other Advance Directives
A DNAR order is a specific medical directive, distinct from other broader advance directives. While “DNR” (Do Not Resuscitate) is often used interchangeably, “DNAR” (Do Not Attempt Resuscitation) is sometimes preferred by the medical community to emphasize that resuscitation attempts may not always be successful.
In contrast, a Living Will is a legal document that outlines a patient’s broader preferences for medical care if they become incapacitated. This document can specify wishes regarding various life-sustaining measures, such as feeding tubes, ventilators, and other life-prolonging treatments. Although a Living Will may include a provision about not wanting CPR, it is not the same as a physician-ordered DNAR.
A Durable Power of Attorney for Healthcare, sometimes called a Healthcare Power of Attorney or Health Care Proxy, designates an individual to make medical decisions on the patient’s behalf if they lose capacity. This designated person acts as the patient’s voice for a wide range of medical choices, including consenting to or prohibiting treatments. While a DNAR is a physician’s order entered into the medical record, a Living Will and Durable Power of Attorney for Healthcare are legal documents that guide broader healthcare decisions, often working together to ensure a patient’s wishes are followed.
Revisiting and Revoking a DNAR
A DNAR order is not a permanent directive and can be revisited or revoked at any time. The patient always retains the right to change their mind and request resuscitation. This flexibility ensures that the order accurately reflects the patient’s current wishes and medical circumstances.
Circumstances that might lead to revisiting a DNAR order include a change in the patient’s medical condition or new information becoming available. If the patient is unable to communicate, their authorized healthcare surrogate or proxy can also initiate the revocation or modification of the order. When a DNAR order is revoked, the attending physician is responsible for removing it from the patient’s medical record and ensuring any physical copies or identification items are destroyed.