A Do Not Resuscitate (DNR) order is a medical directive that has gained increasing recognition in healthcare, allowing individuals to make specific choices about life-sustaining interventions. Despite their growing prevalence, these orders are often misunderstood, particularly concerning their implications for Cardiopulmonary Resuscitation (CPR). This lack of clarity can lead to confusion among patients and their families regarding the scope and purpose of a DNR. This article clarifies what a DNR order entails and what it does not.
Understanding DNR Orders
A Do Not Resuscitate (DNR) order instructs medical professionals not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops beating or they stop breathing. CPR is an emergency procedure involving chest compressions, artificial ventilation, and sometimes electrical shocks or medications, to restore heart and lung function. A DNR order honors a patient’s wishes to decline these interventions, especially when they do not desire aggressive life-prolonging treatments or when successful resuscitation is unlikely. These orders are legal medical directives, often governed by state-specific statutes, ensuring patient autonomy in end-of-life care decisions. A DNR aims to prevent unwanted medical procedures and allow for a natural death process.
What a DNR Order Covers and Doesn’t Cover
A common misconception is that a DNR order means “no medical treatment at all,” but this is inaccurate. A DNR order applies to cardiopulmonary resuscitation and related interventions, such as defibrillation or artificial ventilation. It does not mean a patient will be denied other necessary medical care.
Patients with a DNR order continue to receive all other appropriate treatments for their condition, including pain management, antibiotics, oxygen therapy, and comfort care. For example, if a patient with a DNR breaks a bone, they still receive treatment for the fracture and pain relief. The order’s scope focuses on the response to cardiac or respiratory arrest, ensuring comprehensive medical care consistent with overall treatment goals.
How DNR Orders Are Established
Establishing a DNR order involves a deliberate process centered on patient autonomy and informed consent. A competent adult patient can initiate the discussion with their healthcare provider. If the patient is unable to make decisions, a legally authorized surrogate, such as a healthcare power of attorney or a designated family member, can consent on their behalf. The healthcare provider, usually a physician, discusses the implications of a DNR, including the benefits and potential burdens of CPR, to ensure the patient or their representative fully understands the decision. This discussion and the patient’s wishes are then formally documented in the medical record.
Changing or Revoking a DNR Order
A DNR order is not a permanent decision and can be changed or revoked at any time. If a patient is competent, they can verbally or in writing inform their healthcare team that they wish to revoke or modify their DNR order. This flexibility ensures that a patient’s evolving wishes and medical circumstances are accommodated.
If a patient has a legally authorized decision-maker, that individual can also revoke the DNR order on the patient’s behalf. Healthcare providers are obligated to honor the most current expressed wishes of the patient or their authorized representative. Upon revocation, the order is removed from the medical record, and any physical identifiers, such as bracelets or forms, should be voided or destroyed.