Why someone might want a DNR order
When someone nears the end of life -- from either a specific terminal illness or overall decline -- there may be some difficult decisions to make regarding medical interventions. One of these decisions is whether the person wants to be revived, through the administering of CPR (cardiopulmonary resuscitation), if she stops breathing or her heart stops beating.
If she doesn't want to be resuscitated, there are steps you can take to help her formalize that wish in a legally recognized medical order, called a Do Not Resuscitate (DNR) order, and to ensure that it's honored.
CPR can restart a person's heartbeat or breathing when it has stopped. In other words, it can be a lifesaver. So why wouldn't someone want a procedure that might save her life?
People have different reasons for not wanting CPR. For someone old and frail or seriously ill, CPR might work only partially, leaving the person breathing but brain-dead, with a heartbeat but needing artificial breathing, or in some other vegetative condition. Many people would rather let nature take its course than wind up in such a state.
Also, many people nearing the end of life have simply had enough of battling with their deteriorating condition, and they're willing to let go of life when their body tells them it's time.
Kinds of DNRs
A doctor and a patient often consider a DNR order when the patient is entering a hospital for surgery or other treatment, if the patient is terminally ill, or her overall physical condition is severely and permanently diminished.
If both doctor and patient agree that a DNR order is the right decision for the patient, the doctor enters the order into the patient's medical chart. As long as the patient is in the hospital, that DNR order in the chart must be respected by all medical personnel.
If the patient is not in the hospital, an out-of-hospital DNR order form should be completed by the patient and the doctor. This is true even if the patient had a DNR while in the hospital.
Discussing a DNR with the person in your care
Raising the subject of a DNR order with an older adult can be emotionally tough. If someone in poor health is about to enter the hospital for surgery or other treatment, that might be a good time to talk about it. Or, if you're going to have a discussion with the person in your care about a will, power of attorney, or an advance medical directive, that may be a good time to ask about a DNR, too.
- Talk about the positives and negatives of CPR, and explain that she can decide not to get CPR if she doesn't want it.
- Also let her know that if she wants to explore the subject further, she can and should discuss it with her physician. Her doctor may be able to provide her with more detail, or she may simply want to hear the subject explained by a professional.
- You can suggest to her that she discuss it with her doctor at her next appointment, or you can call the doctor's office to see about setting up a special appointment just to talk about the issue. Ultimately, if she wants a DNR order put in place, she'll need her doctor's participation anyway.
The doctor's approval of a DNR order
In order for a DNR to have legal effect -- meaning that it would be entered into the patient's hospital chart, and that emergency medical personnel would have to honor it outside a hospital setting -- it must be signed by a patient's physician.
- To begin the process of executing a DNR order, a patient has to discuss the subject with her regular physician. If both patient and doctor agree on a DNR order, the doctor will enter it in the patient's medical records.
- For a DNR order to have effect outside a hospital setting, a DNR form must be prepared by the patient and doctor, regardless of whether a DNR order was in effect during a hospitalization. Any medical personnel would honor this form if they responded to an emergency at the person's residence (whether at home, in an assisted-living facility, or in a nursing home).
Preparing a DNR order form
The best and easiest place to get a DNR form is at the doctor's office. The doctor should have a form that he and the patient can fill out together. This ensures that the form used is the one recognized in the state where the patient lives.
If the doctor's office doesn't have the form (or simply to see what the form looks like), you can get a sample version by going online and entering the words DNR form and the name of your state. You can then use your state's form, filling it out and having the person in your care present it to the doctor for signature.
What to do with a DNR form
Outside the hospital, a DNR order won't do any good if emergency responders don't know about it. To make sure that emergency medical personnel would see a DNR order, copies of it should be prominently displayed where the older adult lives.
- Many people post a copy on the inside of the front door, on the refrigerator, in the bathroom, or in other prominent places around the house.
- Some people also wear a piece of identification jewelry -- a bracelet or necklace -- that indicates that a DNR order is in place. It alerts emergency rescue personnel to look for the posted form.
- Some of these identification pieces also provide a toll-free number to call. You can find out about these identification pieces by going to the website of the nonprofit MedicAlert Foundation.