The Do Not Resuscitate Comfort Care order is a medical instruction designed to guide treatment when a person faces a medical crisis, particularly at the end of life. This specialized order ensures that a patient’s wishes for a peaceful death are respected by medical professionals across all care settings. It defines a clear boundary: aggressive measures intended to reverse death are withheld, while all treatments focused on maintaining comfort and dignity are provided. The order is a formal part of advanced care planning, shifting the focus from prolonging life to maximizing the quality of remaining time.
Understanding Do Not Resuscitate
A Do Not Resuscitate (DNR) order is a physician’s directive placed in a patient’s medical chart that instructs the healthcare team to withhold cardiopulmonary resuscitation (CPR) if the patient’s heart stops beating or they stop breathing. The core purpose of this order is to prevent invasive and often unsuccessful procedures when a person is seriously ill or near the end of life. CPR involves a number of aggressive interventions, including chest compressions, the administration of powerful cardiac drugs, and the use of electric shock (defibrillation).
The DNR order also covers related life-saving measures that follow CPR, such as intubation. Intubation involves inserting a tube into the windpipe to connect the patient to a mechanical ventilator for breathing support. For a patient with a DNR, these attempts to restart the heart or breathing are considered unwanted interventions. A DNR order is precisely limited to resuscitation and does not mean “do not treat” the patient for other medical conditions.
The Philosophy of Comfort-Focused Care
Comfort Care describes a medical philosophy that prioritizes the relief of suffering and the enhancement of a patient’s quality of life. This model represents a shift in the treatment goal from attempting to cure an underlying disease to maximizing the patient’s comfort. Comfort-focused care, often delivered under the umbrella of palliative care, involves an aggressive approach to symptom management.
The intent is to control distressing physical symptoms like pain, nausea, shortness of breath, and anxiety. This care model can be implemented at any stage of a serious illness, not just the final moments of life. Comfort Care ensures that a person is treated with dignity and honors the patient’s personal goals over the extension of life.
What the Combined Order Means for Treatment
The DNR Comfort Care order unites the refusal of resuscitation with the commitment to aggressive symptom management. Under this combined order, medical staff are explicitly instructed to provide all necessary measures to keep the patient comfortable. This includes administering medications to manage pain, control anxiety, and alleviate breathing difficulties.
The order permits the use of standard medical treatments that contribute to comfort, such as oxygen therapy, manual feeding, and wound care. Intravenous fluids and antibiotics may also be provided if they are judged to relieve suffering, for example, by treating a painful infection or managing dehydration.
However, the order strictly prohibits interventions intended solely to prolong life, such as mechanical ventilation, defibrillation, or aggressive diagnostic testing and surgery that do not align with the goal of comfort. This boundary ensures the patient avoids the burden of medical interventions that could compromise their comfort.
Discussing and Documenting End-of-Life Wishes
The process of enacting a DNR Comfort Care order begins with an informed discussion between the patient, their family or surrogate decision-maker, and their physician. This conversation should cover the patient’s prognosis, the likely outcomes of resuscitation, and their personal values concerning end-of-life care. The final decision must be voluntary and based on a clear understanding of the consequences of the order.
The patient’s wishes are formally documented through a medical order, which may be called a Physician Order for Life-Sustaining Treatment (POLST) or Medical Orders for Scope of Treatment (MOST). Unlike an Advance Directive, which outlines general wishes, these forms are actionable medical orders that follow the patient across different care settings. Because patient conditions and preferences can change, the order is not permanent and can be revoked or modified by a patient who retains decision-making capacity.