4 Things You Must Know About Do Not Resuscitate Orders

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“Do Not Resuscitate” orders (DNRs for short) are instructions to health care providers and first responders to withhold resuscitation techniques, like CPR, when a patient’s breathing or heart stops. They’re most frequently used by people who are terminally ill or in declining overall health due to advanced age.

You have the right to refuse resuscitation efforts, but you need to formalize your wish in a DNR in order to ensure that it is honored. While the definition of a DNR might seem straightforward, understanding the nuances and what is governed by a DNR can be a bit tricky. Here’s what you need to know to help make the best decision for your health care.

1. Do Not Resuscitate orders only apply to situations where your heart stops beating or you stop breathing

DNRs are legal orders that allow a person to decline cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), in the event that his or her heart stops beating or if he or she stops breathing. Some forms also allow you to specify DNI, or Do Not Intubate, meaning that you decline having a breathing tube connected to a ventilator to help you breathe if needed.

Outside of these procedures, a DNR or DNI order doesn’t affect any other treatment, so even with a DNR in place you can still receive other life-saving medical treatments, medicines and surgeries.

If you wish to specify other treatments you do or do not want to receive, you may want to consider a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) instead. (Related: POLST and MOLST Forms: An Important Tool for End-of-Life Care)

2. To be official, a physician has to sign off

A DNR is technically a physician’s order, meaning that a physician or a member of the hospital staff writes the order based upon the wishes of a patient or the patient’s health care proxy. In order for it to be legally binding, it needs to be signed off on by a patient’s physician.

Typically, upon admission to the hospital you can get a physician to sign off on a DNR and enter it into your medical charts. But be aware that depending on your state, if you are discharged from the hospital, that DNR may no longer apply at your home or in a long-term care facility like a nursing home. Be sure to check with the physician handling your discharge.

Outside a hospital setting, you can discuss the subject with your physician, and your doctor will enter the state’s form into your records. You should make sure to keep a copy on your person and in your home—on the refrigerator is a good place, so emergency medical personnel can find it easily.

3. Advance directives and living wills aren’t enough

An advance directive or living will is a document created directly by you, detailing the medical care you wish (or don’t wish) to receive if incapacitated. But even if your living will says you do not wish to be resuscitated, without the proper state form co-signed by a physician, emergency medical services personnel may attempt to resuscitate you if your breathing or heart stops. It’s therefore essential that your DNR be kept on file with your physician, and a copy be kept on your person in case of emergency.

4. You can always change your mind

Like most health care decisions, a DNR or DNI isn’t set in stone. Even if you’ve established one with your physician or hospital staff, you can always change your mind. Just note that, because DNRs are technically physician’s orders, you must consult with a doctor to make the change official.

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