Online Will Blog

What Is a DNR Order and How Does It Work?

A Do Not Resuscitate (DNR) order is a medical order written by a physician instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops beating or they stop breathing. Without this order, healthcare providers are legally obligated to attempt resuscitation—even for those with terminal illnesses or advanced age where CPR may be ineffective or unwanted.

Research from the National Institutes of Health shows that many people misunderstand what CPR involves and its actual success rates. CPR can include:

• Chest compressions (potentially breaking ribs)
• Electric shock to the heart
• Insertion of breathing tubes
• Administration of resuscitation medications

Unlike what television portrays, CPR success rates vary dramatically by circumstance. For hospitalized patients with certain conditions, success rates can be under 20%, with even lower rates for those with serious chronic illnesses. Understanding these realities forms the foundation for making informed DNR decisions.

Different Types of DNR Orders Explained

Several types of DNR orders exist, each applying in different settings:

In-Hospital DNR: Applies only while you're a patient in a hospital setting.

Out-of-Hospital DNR: Applies in community settings such as your home, long-term care facilities, or during transport. This typically requires specific forms recognized by emergency medical services in your region.

POLST Forms: Physician Orders for Life-Sustaining Treatment forms include DNR instructions along with other medical orders and are recognized across healthcare settings. The National POLST organization notes these are particularly appropriate for those with serious illness or frailty.

DNR Bracelets or Cards: Some jurisdictions offer official DNR jewelry or identification cards to alert emergency personnel to your DNR status.

Understanding which type applies in which circumstance is crucial for ensuring your wishes are honored across all settings.

The Relationship Between DNR Orders and Living Wills

Living wills and DNR orders work together but serve different functions in your advance care planning:

Living Wills: These documents express your general wishes regarding a broad range of medical treatments, including but not limited to resuscitation. They typically take effect only when you cannot make decisions and are certified to be in specific medical conditions (such as terminal illness or permanent unconsciousness).

DNR Orders: These are specific medical orders that take effect immediately upon being signed by a physician, regardless of your current condition or decision-making capacity.

While your living will might express your DNR wishes, it doesn't function as an actual DNR order. Healthcare experts recommend that your living will clearly state your resuscitation preferences, which can then guide your physician in writing a DNR order when appropriate.

The team at Evaheld can help you understand how to effectively integrate these complementary documents in your advance care planning.

Factors to Consider When Making DNR Decisions

Deciding whether a DNR order aligns with your values involves weighing several important factors:

Your Current Health Status: Those with advanced illness or frailty might view the benefits and burdens of CPR differently than those in generally good health.

Quality vs. Quantity of Life: Consider how you balance additional time versus quality of life, recognizing that successful CPR might lead to diminished function or increased dependence.

Likelihood of Success: Discuss with healthcare providers the realistic chances of successful resuscitation given your specific medical conditions.

Potential Outcomes: Understand what life might look like following successful CPR, including possible neurological effects, breathing tube dependence, or intensive care stays.

Religious, Cultural, or Personal Beliefs: Consider how your spiritual or philosophical perspectives influence this decision.

The American Medical Association Journal of Ethics emphasizes that DNR decisions should be made through informed discussions with healthcare providers, focusing on individual goals and values rather than universal recommendations.

Evaheld's comprehensive planning resources help guide your thinking on these complex considerations, ensuring your decisions truly reflect your personal values.

Common Misconceptions About DNR Orders

Several misconceptions about DNR orders can lead to poor decision-making:

Misconception: DNR means "do not treat" Reality: DNR only addresses CPR. You can still receive all other appropriate medical treatments, including intensive care and interventions like antibiotics, surgery, or chemotherapy.

Misconception: DNR decisions are permanent Reality: You can change your DNR status at any time if you're capable of making decisions.

Misconception: DNR is only for the elderly or terminally ill Reality: Anyone can choose a DNR based on their personal values and preferences.

Misconception: Having a DNR means healthcare providers won't try as hard Reality: Studies demonstrate that DNR status does not reduce the quality of other aspects of medical care.

Understanding these facts helps ensure your DNR decisions are based on accurate information rather than misconceptions.

How to Document Your DNR Wishes in Your Living Will

Your living will should clearly address your wishes regarding resuscitation in various scenarios. Consider these approaches:

Scenario-Based Instructions: Rather than a blanket statement, consider addressing CPR in different circumstances:

• If you have a terminal condition with no reasonable hope of recovery
• If you're permanently unconscious
• If you have advanced dementia
• If you're seriously ill but have prospects for recovery

Values Clarification: Explain the reasoning behind your DNR preferences, which helps guide interpretation in situations not explicitly covered.

Healthcare Agent Guidance: Provide specific guidance to your healthcare representative about how to make DNR decisions on your behalf in various circumstances.

The American Bar Association's Commission on Law and Aging recommends that living wills address resuscitation specifically rather than relying on general statements about "heroic measures."

Evaheld provides specialized templates that help you articulate your DNR wishes clearly and comprehensively within your living will.

Communicating Your DNR Wishes Effectively

Beyond documentation, effective communication about your DNR wishes is crucial:

Conversations with Healthcare Providers: Discuss your DNR preferences explicitly with your primary care provider and specialists. These conversations should explore your values, concerns, and questions about CPR.

Family Discussions: Research shows that families who understand DNR decisions experience significantly less distress when these orders are implemented. Explain your reasoning to reduce potential disagreement or guilt.

Healthcare Representative Preparation: Ensure your appointed healthcare agent clearly understands your DNR wishes and the circumstances under which you would or wouldn't want resuscitation attempted.

Regular Review: Revisit your DNR preferences periodically, especially after changes in health status, as your views may evolve over time.

Evaheld's conversation guides help facilitate these important discussions, ensuring your DNR wishes are clearly understood by those who may need to implement or advocate for them.

Special Considerations for Different Life Stages

DNR decisions may vary based on your stage of life and health status:

Healthy Adults: Many healthy individuals choose against DNR orders, as CPR has higher success rates in sudden, unexpected cardiac events in otherwise healthy people.

Individuals with Chronic Progressive Illness: As illness advances, the benefits and burdens of CPR shift, potentially making DNR more aligned with overall goals of care.

Advanced Age: Research indicates that CPR outcomes tend to be poorer in very elderly individuals, which might influence DNR decisions.

Terminal Illness: Those with terminal diagnoses often choose DNR as part of a comfort-focused approach to care.

Understanding how these factors influence CPR outcomes helps you make decisions appropriate to your specific situation.

Conclusion

DNR decisions represent some of the most significant choices in advance care planning. By understanding what these orders entail, considering your personal values, and clearly documenting your wishes, you ensure your preferences regarding resuscitation will be honored across healthcare settings.

Remember that DNR decisions should align with your broader goals of care and quality-of-life priorities. These choices are deeply personal, reflecting your unique values, beliefs, and healthcare objectives.

With thoughtful consideration and clear documentation through platforms like Evaheld, you can make DNR decisions that truly reflect your wishes while providing valuable guidance to healthcare providers and loved ones. The peace of mind this brings—knowing your preferences regarding this critical intervention will be respected—is immeasurable.