A Do Not Resuscitate (DNR) Comfort Care order is a specific type of advance care planning that shifts the focus of medical intervention from extending life to maximizing its quality. This formalized instruction guides healthcare providers to respect a patient’s wish to forgo life-prolonging measures while receiving comprehensive support for comfort and dignity. The decision to pursue a DNR Comfort Care plan is personal, developed through discussion with family and medical professionals. Understanding the distinct components of this order ensures a patient’s end-of-life preferences are honored.
Defining the Do Not Resuscitate Order
A Do Not Resuscitate (DNR) order is a medical instruction written by a healthcare provider, such as a physician, informing the medical staff not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops or breathing ceases. The order is specific to cardiac or respiratory arrest and prevents invasive, unwanted treatment at the end of life. CPR involves chest compressions, artificial ventilation, and potentially electric shocks or specialized drugs.
The DNR order addresses only resuscitation and does not automatically preclude all other forms of medical treatment. A common misconception is that a DNR order means “do not treat,” but it simply means that if the patient dies naturally, no attempts will be made to reverse that death. For a DNR order to be legally recognized and effective outside of a hospital setting, it often requires documentation on specific forms, which can vary by state, such as a Physician Orders for Life-Sustaining Treatment (POLST) or state-issued DNR forms.
The Scope of Comfort Care
Comfort care represents a philosophy of medical treatment that prioritizes symptom management, dignity, and quality of life over the pursuit of a cure or the aggressive extension of life. This approach is often synonymous with palliative care, focusing on alleviating suffering in its physical, emotional, and spiritual forms. The goal is to ensure the patient experiences maximum comfort, even if the underlying disease is not being treated.
This type of care shifts the focus from a curative model to a supportive one, recognizing that for some serious illnesses, the burden of aggressive interventions outweighs the potential benefits. It means doing everything possible to manage symptoms like pain, nausea, shortness of breath, and anxiety.
Under a DNR Comfort Care order, the comfort protocol is activated immediately upon the order being issued. This differs from variations like a DNR Comfort Care-Arrest, which allows for full medical treatment until cardiac or respiratory arrest occurs. Choosing the pure Comfort Care option means all current and future medical decisions are primarily driven by the goal of comfort, establishing a clear boundary against life-prolonging measures.
Treatments Included and Excluded in a Comfort Care Plan
The combination of a DNR order with a Comfort Care designation creates a comprehensive plan that clearly delineates which medical actions are appropriate and which are not. Interventions that directly manage symptoms and promote comfort are always included and encouraged. These can include administering pain medication, anti-nausea drugs, and oxygen therapy to relieve shortness of breath. Basic medical care, wound care, and manual feeding are also provided to ensure the patient’s well-being and hygiene.
Included Treatments
Even certain treatments that are typically aggressive may be used if their primary purpose is comfort, not cure or prolongation of life. For example, antibiotics may be used to treat a painful infection, such as a urinary tract infection, if the infection is causing distress and the goal is to relieve suffering. Hydration via an intravenous line can be provided specifically for comfort, but not to artificially prolong the process of dying.
Excluded Treatments
The Comfort Care designation explicitly excludes interventions that are considered aggressive and life-sustaining. The exclusion of these measures is consistent with the decision to avoid treatments that primarily serve to prolong life when the patient’s condition is terminal.
Excluded treatments typically withheld include:
- Mechanical ventilation (placing a patient on a breathing machine).
- Feeding tubes.
- Dialysis.
- Aggressive surgery.
- Admission to an intensive care unit (ICU) for life support.
Implementing and Communicating the Decision
Establishing a DNR Comfort Care plan requires clear and supportive discussions between the patient, their family, and the healthcare team. The physician must ensure the patient fully understands the nature of their illness, the prognosis, and the consequences of the DNR and Comfort Care choices. It is important to discuss these preferences before an emergency occurs, while the patient can still communicate their desires clearly.
The decision must be formally documented using the appropriate legal paperwork recognized by the state or healthcare system. These documents, often referred to as Physician Orders for Life-Sustaining Treatment (POLST) or similar portable medical orders, translate the patient’s wishes into immediately actionable medical orders. The patient should also identify a medical decision-maker, such as a healthcare power of attorney, to speak on their behalf if they become unable to communicate.
Regularly reviewing and updating the DNR Comfort Care order is necessary as the patient’s condition evolves or their preferences change. The healthcare team must ensure the documentation is visible and accessible, especially for emergency medical services (EMS) personnel outside of a hospital setting. Open communication ensures that the patient’s goal of a comfortable and dignified end-of-life experience is consistently respected.