Understanding DNR Orders: Medical and Legal Perspectives
DNR stands for do not resuscitate. In most cases, DNR orders are provided by physicians for patients who request them. DNR orders essentially notify health care providers that they are not to perform cardiopulmonary resuscitation, or CPR, for the individual to whom the DNR references.
CPR uses either mouth-to-mouth assistance, machine-assisted breathing methods or chest compressions to restore the beating of a person’s heart and the movement of their lungs when their heartbeat or breathing patterns have stalled. CPR is an emergency-level rescue technique that can save the lives of people in need of heart- and lung-related help.
If you do not have a DNR order in place, it is typically protocol for health care providers to begin administering CPR in the event of an emergency. Unfortunately, while CPR is an effective practice, emergency providers warn that CPR often involves the use of such strenuous pressure that the ribs may crack or break entirely.
For this reason, health care providers will try to refrain from using CPR unless it is absolutely necessary. In circumstances in which CPR is not successful, there are usually preexisting factors that impact the lack of success, namely widespread cancer or infections or other terminal illnesses.
Here is more insight to keep in mind:
- CPR is not intended for people who are terminally ill or for those who have severe health problems. This is because CPR has a lower success rate for patients in these categories.
- A patient’s quality of life may suffer if medical professionals attempt to administer CPR to patients who are not fit to receive it. Even so, CPR may not be successful even for patients who are healthy outside of the context of needing CPR.
- Though patients are likely to survive rounds of CPR, they may sustain damage to their brains or various other organs. It could be the case that patients are permanently dependent on a machine to breathe despite CPR efforts as well. This possibility can be particularly plausible regarding the elderly or the frail.
- CPR is strongly discouraged when death is imminent. This is because CPR is an aggressive form of medical intervention, which is an anathema to a peaceful death.
Facing tough decisions
Decisions about resuscitation often fall on the shoulders of loved ones in situations in which the patients are either incapable of consciously agreeing to medical care or refuse medical treatments themselves despite being of sound mind. However, the best-case scenario is when these types of decisions involve the input of the patients themselves because patients have the right to autonomy.
From a legal standpoint, all people hold the inherent right to determine what is done to their own bodies as long as the person meets the requirements of being an adult and being of sound mind. Additionally, in terms of morals, your own personal values and preferences will apply when you make your final decision.
If you are not sure where your beliefs lie in terms of resuscitation orders, you can work together with your physician and other health care professionals whom you trust. With medical knowledge and possible treatment options in mind, you can weigh all of the facts before you make your decision about DNR orders.
Additionally, make sure you speak with your physician and other health care professionals whom you trust. Start by asking your doctor about what he or she would recommend within the context of your medical history and your health conditions.
Also, consider what you deem to be important to you, and have conversations with your family members or friends as you make your decision. You might even want to seek counseling from clergy members, therapists or social workers, all of whom have experience helping people discover their stance on DNR orders.
Can you change your mind?
Let’s say you decide to establish a DNR order for yourself. What if you change your mind in the future? Can you retract your DNR order later on?
The answer is yes, of course you can change your mind! You will just need to schedule an appointment with your physician because official DNR orders are provided to patients by their doctors.
Does a DNR order have any impact on other forms of medical care? Luckily, the answer is no. All other medically related treatment will continue to be carried out unless you decide to limit it yourself or your health care providers no longer deem said treatment to be necessary.
So how exactly do you get your thoughts across when seeking a DNR order for yourself? It all starts with filling out a special form that can be obtained from the Department of Public Health. You must complete the form before your request for a DNR order will be honored. If you would rather go through the process via your doctor instead of reaching out to the Department of Public Health, simply ask your doctor for assistance with the form.
You should never be in a position where your wishes are either not communicated or not respected, which is why DNR orders exist in the first place. Your health care team will be reliant on your health care proxy or living will, so ensuring that you have one in place prior to medical treatment is key.
If you have not planned for this moment in advance, then medical professionals will rely on family members to make a decision on your behalf based on what they believe your wishes to be. Every patient who is capable of making decisions related to their autonomy has a legal right to do so.
It is the duty of health care providers to honor and respect your wishes as a patient. But of course, keep in mind that this is merely an introduction to a complicated and multidimensional issue.
When weighing your options regarding DNR orders, take the time to speak with your physician, an attorney or your loved ones before finalizing a decision for yourself.