There is a misconception that the orders Do Not Resuscitate mean Do Not Treat. This is, in fact, false. I have been honored to be a Palliative Care Nurse Practitioner for quite a few years now. I have had these conversations with many people. It is a time when people may not be at their best. They may not be thinking clearly. I try my best to answer all questions even before they are asked, as many times one cannot even think of the right questions.
When I approach a family regarding making a patient status a Do Not Resuscitate, it is usually when treatment for their condition have failed to produce an improvement in the patient’s condition, or the treatment risks far outweigh any possible benefit. It may be at this time that it is better for the patient to withdraw treatment and allow a natural death to take place. When death will take place, is not for us to say.
Do Not Resuscitate order or DNR is an order placed in a patient’s chart, or is a part of their living will. Do Not Resuscitate means that in the event that your heart stops beating, no heroic measures will be taken to restart the heart. Heroic measures include: 1) CPR (cardiopulmonary resuscitation) – chest compressions and assistance with the person’s breathing, 2) Cardiac defibrillation – shocking the heart back into an appropriate rhythm, 3) IV push medication to help restart the heart, when it is not beating or beating correctly. It is important to note that all of these measures are needed for any chance that the person can be resuscitated.
The American Heart Association reports that less than 8% of all sudden cardiac arrests are successfully resuscitated. This percentage is probably skewed for the mere fact that many older patients in the hospital that suffer cardiac arrest from advancing disease or terminal illness have very little chance of being resuscitated. The success of CPR depends on the patient’s overall medical condition. Age alone does not determine whether CPR will be successful, although illnesses and frailties that go along with age often make CPR less successful.
When patients are seriously ill, terminally ill, or advanced in age CPR may not work or may only partially work, leaving the patient brain-damaged or in a worse medical state than before the heart stopped. In these cases, some patients prefer to be
cared for without aggressive efforts at resuscitation upon their death.
A Few Facts about DNR Orders:
- IF I REQUEST A DNR ORDER, MUST MY DOCTOR HONOR MY WISHES?
If you don’t want CPR and you request a DNR order, your
doctor must follow your wishes or:
– transfer your care to another doctor who will follow your
– begin a process to settle the dispute if you are in a
hospital or nursing home.
If the dispute is not resolved within 72 hours, your doctor
must enter the order or transfer you to the care of another
- WHAT IF MEMBERS OF MY FAMILY DISAGREE?
In a hospital or nursing home, your family can ask that the
disagreement be mediated. Your doctor can request mediation
if he or she is aware of any disagreement among your family
- WHAT HAPPENS IF I CHANGE MY MIND AFTER A DNR ORDER HAS BEEN WRITTEN?
You or anyone who consents to a DNR order for you can remove
the order by telling your doctor, nurses or others of the
- IF I AM AT HOME WITH A DNR ORDER, WHAT HAPPENS IF A FAMILY MEMBER OR FRIEND PANICS AND CALLS AN AMBULANCE TO RESUSCITATE ME?
If you have a DNR order and family members show it to
emergency personnel, they will not try to resuscitate you or
take you to a hospital emergency room for CPR.
While this can be a hard conversation to have, it is a very important conversation. It is important that your family know your wishes. You are never too young to have these conversations with your spouse, parents, or siblings.