I remember sitting with Mr. Henderson and his wife, sunlight streaming into the clinic room. He was tired, you could see it in his eyes, but his mind was sharp. “Doc,” he said, his voice a little raspy, “we need to talk about… well, about what happens if things get really bad.” That conversation, the one about a Do-Not-Resuscitate order, is one of the toughest, but also one of the most important, we can have. It’s about making sure your voice is heard, even when you might not be able to speak for yourself.
So, what exactly is a Do-Not-Resuscitate order, or DNR as we often call it? Think of it as a clear instruction you give us, your medical team. It’s a type of advance directive – a way to make your wishes known ahead of time, specifically about life-sustaining treatments if your heart or breathing stops.
Normally, if your heart stops or you stop breathing, our first instinct, our training, everything in us, is to jump in and do everything possible. We’re talking about things like Cardiopulmonary Resuscitation (CPR) – you know, chest compressions and breathing support. Sometimes it involves intubation, which is placing a breathing tube, and connecting you to a mechanical ventilator, a machine that breathes for you. Or using a defibrillator to send an electrical shock to try and restart the heart.
But what if you’re facing a terminal illness, or a very serious condition where these heroic measures might cause more suffering than good? That’s where a DNR order comes into play. It’s about saying, “I want to limit pain and suffering,” or “I want to maintain my dignity as I approach the end of my life.” It’s a deeply personal choice, and there’s no right or wrong answer, only what’s right for you.
This isn’t a decision made lightly. A healthcare provider, usually your doctor, will write a DNR order after a thorough chat with you. And if you want them there, your family or legal decision-makers can be part of that conversation too. Depending on where you live, the rules about who can officially write one can vary a bit, but it’s typically a physician (an MD or DO) or another designated healthcare professional. Ideally, we talk about this before an emergency. Once decided, the DNR order becomes part of your medical record, so any medical professional involved in your care knows your wishes.
Why Might Someone Choose a DNR Order?
You might wonder, if CPR can save lives, why would anyone choose not to have it? Well, it’s a valid question. For some folks, especially those with advanced illnesses or very frail health, the thought of undergoing CPR and other intensive treatments brings up concerns.
Here’s what I hear in my practice:
- A desire for control: Making this decision can feel empowering. It’s a way to have a say in your own medical care, right to the very end.
- Understanding CPR’s limits: While CPR can be life-saving, it’s not always successful. For people who are already very sick, the chances of it working well can be lower.
- Avoiding potential downsides: CPR, when it’s performed, can be quite forceful. It’s not uncommon to have painful injuries afterward, like broken ribs or a fractured sternum (breastbone). For some, avoiding this potential pain and recovery is a priority.
It’s all about weighing the potential benefits against the potential burdens, in the context of your own life and values.
Understanding Your Do-Not-Resuscitate Order Options
“DNR” is a common term, but there’s a bit more to it. Sometimes the specifics can vary, or you might hear slightly different phrases. It’s good to know the landscape.
Here are some common types or related concepts:
- Do Not Attempt Resuscitation (DNAR): This is essentially the same as a DNR. Some hospitals or regions might use this term instead. It’s just a different label for the same instruction.
- Allow Natural Death (AND): This is a term I’m seeing more, and I quite like it. It focuses on providing comfort and letting nature take its course. The goal is to prevent suffering as life ends, using treatments that keep you as comfortable as possible.
- Do Not Intubate (DNI): This is more specific. It means you don’t want a breathing tube placed down your throat or to be put on a ventilator if you can’t breathe on your own. You might still want other measures, like CPR or medications, but not intubation.
- Specified DNRs: Sometimes, you can tailor your wishes. For example, you might say no to CPR, but be okay with other treatments, like a defibrillator. These are less common but possible.
- Comfort Care Orders: These often go hand-in-hand with DNRs. They focus on what kind of care you do want to receive to keep you comfortable and manage symptoms as you approach the end of life.
The options available can depend on local laws and your specific medical situation. Your doctor can walk you through what’s most relevant for you.
Making Your Wishes Known
So, how do you make this official? It starts with a conversation.
- Talk to your doctor: Your primary care physician or the main doctor overseeing your care is the best person to start with.
- Have an open discussion: We’ll talk about the benefits and risks of CPR and other treatments in your specific situation. This is all about informed consent – making sure you have all the facts to make a choice that feels right.
- Take your time: It’s perfectly okay to say you need to think about it, or discuss it with your loved ones. These are big decisions.
- Formalize it: Once you’ve decided, your doctor will document the DNR order in your medical record. You can also get a copy to keep with you. Some people choose to wear a medical ID bracelet that alerts first responders to their DNR status.
Sometimes, we as doctors might bring up the topic of a DNR order during a routine visit or if you’re admitted to the hospital, especially if you have a serious illness. It’s part of ensuring we understand your full range of wishes.
What If I Can’t Make the Decision Myself?
Life can be unpredictable. If you become unconscious or are unable to make an informed decision due to illness or injury, and you already have a DNR order in your medical record, your loved ones can’t override it. That’s your voice, documented.
If you don’t have a DNR order and can’t make your wishes known, things get a bit more complex.
- Healthcare Proxy/Power of Attorney: If you’ve legally appointed someone to make medical decisions for you (often called a healthcare proxy or durable power of attorney for healthcare), they can speak on your behalf. This is why having these documents in place is so helpful.
- Family Members: If you haven’t named a proxy, a close family member might be able to make decisions. Who that is varies by state law.
Can I Change My Mind?
Absolutely. You always have the right to change your mind about a DNR order. If you decide you no longer want it:
- Tell your healthcare provider immediately. They’ll update your medical record.
- If you have a wearable ID or paper copies, stop using them or destroy them.
- Make sure your loved ones and any caregivers know you’ve changed your mind.
Other Important Considerations
A couple more things often come up in these discussions.
What if a DNR Patient is Resuscitated?
This is a tricky area. A DNR order applies to medical professionals who know about it, or reasonably should know.
- If a healthcare provider doesn’t know about your DNR (maybe it’s an emergency outside a hospital and you have no ID), or if there’s a genuine miscommunication, they usually won’t get into trouble for trying to save a life.
- However, if a provider knows about your DNR and resuscitates you anyway, or if they should have known (like it’s clearly in your hospital chart) and didn’t check, there could be legal or professional consequences for them.
- It’s important to know that nonmedical folks – like a bystander who knows CPR – can’t get into legal trouble for performing CPR on someone with a DNR. If you’re trained in CPR, the general guidance is to attempt it if someone collapses. The nuances of a DNR are usually sorted out by medical professionals once they arrive or if the information becomes available. But if a situation arises where you, as a bystander, definitively know the person has a DNR, respecting those wishes is the ethical thing to do.
DNR Orders and Surgery
If you have a DNR order and you’re scheduled for surgery, this is something you absolutely need to discuss with your surgeon and your anesthesiologist (the doctor who manages your pain and vital functions during surgery).
Sometimes, they might ask you to temporarily suspend your DNR order during the surgery and for a short period afterward. Why? Because some routine parts of surgery, especially general anesthesia, involve procedures that might technically go against a DNR (like supporting your breathing).
It’s vital to have this conversation so everyone is clear on your wishes and how they fit with the planned procedure. Don’t hesitate to ask all your questions. We want to make sure the care you receive aligns with what’s important to you.
Take-Home Message: Key Points on DNR Orders
This is a lot to take in, I know. Here are the main things I hope you’ll remember about a Do-Not-Resuscitate order:
- A DNR order is your instruction to medical teams not to perform CPR or other specific life-sustaining treatments if your heart or breathing stops.
- It’s a personal choice, often made by individuals with serious illnesses or those who want to prioritize comfort and dignity at the end of life.
- Open conversation with your doctor is key to understanding if a DNR order is right for you and what types of orders are available.
- You can always change your mind about a DNR order.
- Discussing your DNR status is especially important if you are facing surgery.
These are tough conversations, but you’re not alone in navigating them. Talking openly with your doctor and your loved ones can bring a lot of peace of mind.
