A Do Not Resuscitate (DNR) order is a medical instruction directing healthcare providers to withhold cardiopulmonary resuscitation (CPR) if a person’s heart stops beating or they stop breathing. The purpose of a DNR is to ensure an individual’s wishes regarding end-of-life care are respected, particularly concerning resuscitation efforts.
What a DNR Means
A DNR order is a specific medical directive, not a broad refusal of all medical care. It exclusively pertains to cardiopulmonary arrest, instructing medical personnel not to perform interventions like chest compressions, artificial ventilation, or defibrillation if the heart or breathing ceases. While CPR can be a life-saving measure, a DNR ensures these aggressive efforts are not initiated. This directive does not prevent other medical treatments.
Individuals with a DNR can still receive medical care for conditions such as infections, pain management, or other illnesses. For instance, a person with a DNR would still be given antibiotics for pneumonia or medication for pain relief. The order focuses solely on the decision to forgo resuscitation attempts, allowing for continued comfort care and other appropriate medical interventions.
Personal Reasons for a DNR
Many individuals choose a DNR order to prioritize their quality of life over extending life at all costs, especially when facing severe or irreversible medical conditions. They may wish to preserve dignity and comfort, particularly if aggressive interventions are unlikely to improve their overall outcome. This decision often reflects a desire to avoid prolonged suffering from resuscitation attempts that are unlikely to be successful. For very ill people, CPR can lead to painful injuries like broken ribs or sternum fractures, and the odds of success can be significantly lower.
A person’s medical prognosis frequently influences the decision to obtain a DNR. When medical professionals indicate that resuscitation attempts are unlikely to be effective or could lead to a severely diminished state, patients may opt for a DNR. This is common for individuals with terminal illnesses, serious chronic conditions like heart failure, or those experiencing declining functional abilities. The choice is often rooted in a fear of undergoing futile treatment that offers little chance of meaningful recovery and could result in a vegetative state or severe disability.
Personal beliefs and values also play a significant role in this decision. These decisions can align with spiritual, philosophical, or ethical convictions about the natural course of life and death. Some individuals prefer to die peacefully without medical interference, believing that certain treatments might prolong life without enhancing its quality.
How a DNR is Established
Establishing a DNR order typically involves a discussion between the individual and their physician. The physician will provide the necessary forms, which the patient then signs. Most states require a written and signed DNR, as verbal requests may not be legally recognized.
Once signed, the DNR order is added to the patient’s medical chart. For individuals outside a hospital setting, such as at home or in a nursing facility, specific out-of-hospital DNR forms may be required. Some states also offer wallet cards or medical ID bracelets to alert emergency personnel of a person’s DNR status. Informing family members and healthcare proxies about the DNR decision is crucial to ensure wishes are respected.
DNR and Other Healthcare Directives
A DNR order is a component of advance care planning, but it differs from other healthcare directives like a Living Will or a Durable Power of Attorney for Healthcare. A Living Will is a legal document that outlines broader wishes for medical treatment in various end-of-life scenarios, not just cardiopulmonary arrest. It can specify preferences regarding life-sustaining procedures such as breathing tubes, artificial nutrition, or dialysis. While a Living Will might include a preference against resuscitation, a DNR order is specifically designed for that singular purpose.
A Durable Power of Attorney for Healthcare, also known as a healthcare proxy, designates a trusted individual to make medical decisions on one’s behalf if they become unable to communicate their wishes. This designated person, or agent, can then interpret and act upon the patient’s wishes, including decisions about a DNR, if the patient has become incapacitated. These documents offer a more comprehensive approach to directing future medical care and can complement a DNR, providing a layered approach to ensuring an individual’s healthcare preferences are honored.