A Do Not Resuscitate or DNR is a legal document that tells emergency responders and healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. Signed by you and your doctor, a DNR will be held in your medical records in case of an emergency event.
What is a DNR?
A DNR is signed by both your doctor and yourself that allows you to choose whether or not you would like CPR in the event you stop breathing or your heart stops beating. This document does not cover other treatments like medicine or nutrition. Ideally, a DNR will be created in advance before an emergency occurs so medical professionals know your wishes. This DNR order will need to be in your medical files for all medical staff to see and easily find.
What’s CPR Stand for?
CPR stands for cardiopulmonary resuscitation. CPR is one of the first steps taken when an individual stops breathing or becomes unresponsive. When discussing CPR in terms of a do not resuscitate order CPR refers to
- Mouth-to-mouth breathing
- Chest compressions
- Use of electricity or medication to restart the heart
- Breathing tubes
Do Not Resuscitate Laws by State
Each state allows for DNR orders, but there can be differences in the law and terminology. Some states require a doctor to sign the order while in others a nurse practitioner can sign off. In various states, they use alternative terms like No Code Order(NCO), Allow Natural Death (AND), or Do Not Attempt Resuscitation (DNAR). DNRs do not transfer from state to state, so if you move states you will need to file a new do not resuscitate order.
Why Would Someone Have a DNR?
Typically a person would consider a DNR if they would likely not benefit from CPR. Commonly people with terminal illnesses will have a DNR.
Some examples of why an individual would consider a DNR include
- Serious chronic illness
- Terminal illness
- Religious beliefs
- Decreasing quality of life or dependency on others
As part of a hospice care plan, a DNR may be included. During hospice care, the main priority is to treat pain or shortness of breath and keep the individual as comfortable as possible, not to prolong life.
How to Get a DNR?
In order to receive a DNR you must ask your doctor or healthcare professional. You can discuss the benefits and disadvantages of having a DNR and see if it's the right fit for you. A doctor will provide you with the DNR forms. These forms can then be filed and kept in your medical records for future care. In addition to having a DNR in your medical records, you can get medical alert bracelets and necklaces with your medical wishes. In some states a medical alert bracelet can take the place of a written DNR order, in others it can not so be sure to check your state's legislation.
Why do People have DNR?
When there is a lower chance of survival individuals choose to have a DNR. In many cases, the risk of pain and harm from CPR can be higher than the benefits. In older individuals who may be frail CPR can cause broken ribs or additional injuries bringing more pain. The physical cost is not worth the benefits, and an individual would rather go naturally. Some individuals don't want to be placed on life support for their last days; they would rather let nature take its course and the DNR allows this. Having a DNR ensures your end-of-life wishes if you are unable to communicate them.
What Happens if You are Unable to Make the Decision?
If you are unable to state your wishes about CPR due to illness or injury the doctors will rely on any DNR already written. If there is no DNR on file you can name someone to decide for you like a legal guardian or health care agent. If you have not named someone to speak for you, a family member can decide to agree or not to a DNR order. This only applies if you are unable to make a medical decision on your own.
Can a Healthy Person Get a DNR?
Anyone over the age of 18 can have a DNR. Any adult can request a DNR form from their doctors regardless of their health status. If an individual has religious or personal beliefs against CPR resuscitation they can file a DNR at any time.
Can You Change a DNR?
You can revoke your DNR at any time. If you decide to change your mind, notify your doctor and destroy all forms as well as copies to ensure the DNR has been removed from your file. Let your family, caretakers, and other medical professionals know of the changes made as well.
Will Medical Personnel Resuscitate a Person With a DNR?
There is never a 100% guarantee a DNR will be followed. This is why it is so important to have your DNR in your records and easily accessible. If medical professionals have any doubts they will provide resuscitation. Keeping your family up to date on your wishes as well as where to find the documentation is key.
A few circumstances a person with a DNR order will be resuscitated are
- No written documentation of a DNR
- The DNR cannot be found or confirmed
- The DNR validity is in question
Can a DNR be Revoked by Family?
If a DNR order is already completed for a person, the family can not revoke the order. Once you filed your DNR forms, medical professionals will follow your wishes regardless of family input. If you do not have a DNR on record and you are unresponsive, your family can then make the decision for you.
The Importance of DNR
A do not resuscitate, DNR order instructs healthcare professionals to withhold CPR treatment in the case of an emergency if an individual stops breathing or their heart stops beating. A DNR form is given by a doctor and filed in medical records. A DNR order can be changed at any time but it cannot be overridden by family members. If an individual prefers nature to take its course, has a terminal illness with a short time left, is on hospice, or has religious beliefs a DNR can ensure their wishes are followed. If you think a DNR is something you would be interested in, talk to your doctor and see what's right for you.