• The InterCare Team

Five Things to Better Understand About a Do Not Resuscitate Order (and What To Do About Them)

What do you know about do not resuscitate (DNR) orders?

If you are like most people, you probably don't know much. This lack of knowledge is understandable given that most people, including some healthcare professionals, don't like to talk about death and the process of dying. It's a challenging discussion to have no matter where you or your loved one might be in the process.

Medline Plus, a website of the U.S. National Library of Medicine, defines a DNR as follows:

"A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating."

A DNR is usually part of a package of written instructions called advanced directives that health care providers are to follow in certain situations. A doctor must order the DNR after talking with the patient, their proxy, or the family.

Here are five things for you to consider about a DNR order.

1. Understand your doctor may think you know more about DNR orders than you do. If you have questions about a DNR, no matter how small you think they are, you need to ask your doctor. Your doctor may not realize you don't understand all aspects of a DNR.

2. Know that doctors may differ at which point they decide to discuss a DNR order. Doctors may introduce the concept of a DNR order at initial diagnosis, when a poor prognosis is determined, or when talking about a referral to a palliative care program. You could wait until your doctor determines the best time to discuss a DNR order. Or you can bring up the subject yourself. If you need support in having this discussion, you can bring in an informed family member, caregiver, or care coordinator to help with asking questions. The sooner you understand your choices and document them, the fewer decisions you will need to make when you are facing more difficult health challenges.

3. Realize your family and current caregivers may not be well-informed about DNRs. For example, many people think a DNR order means no treatment, which is not true. Also, family, friends, and caregivers may have their own beliefs and fears about death and dying that may not guide you in the way that is most beneficial to your process.

4. Educate yourself on the limitations of CPR. This post by Brigham Health lists three situations in which a patient may not want CPR attempted:

a. There is no expected medical benefit. For example, CPR is unlikely to be successful for people who are terminally ill or have severe health problems.

b. Quality of life would decrease. Especially for the elderly and medically fragile populations, CPR may only be partly successful, and the brain or other major organs may suffer damage that requires a machine for breathing.

c. When the death is expected, CPR may be seen as an "aggressive intervention." CPR may disrupt what the patient views as a natural death.

Many people assume CPR is always beneficial, but sometimes it is not. Thinking about these situations will help you make a more informed decision about a DNR order.

5. Consider how a DNR order (or other advanced directives) allows you to be in control of an aspect of your death. None of us is going to avoid dying. Evading the discussion of death does not stop it from happening. However, having the opportunity to make decisions about the process may bring comfort and a sense of control to you.

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