Johns Hopkins Health Alert
Talking About A Difficult Subject -- DNR Directives
A do-not-resuscitate (DNR) order often isn't discussed until it's too late. When reviewed before an emergency occurs, this document can guide your family and communicate your wishes to the people who carry them out: doctors, nurses, emergency medical technicians, and paramedics.
A DNR order is a legal document indicating that you should not be resuscitated in the event of a sudden cardiac arrest or pulmonary arrest. Most states have laws that require hospital staff and emergency medical workers to resuscitate patients in their care, however a DNR order overrides state laws to resuscitate.
The fact that it is legally binding differentiates a DNR order from advanced medical directives or living wills, which outline wishes concerning medical therapies like feeding tubes and ventilators or designate a healthcare proxy to make medical decisions on your behalf if you become incapacitated. Here are some points about DNR to keep in mind:
- If you choose to complete a DNR order while you are hospitalized, the form will go into your medical record at that hospital. There are nationwide electronic DNR databases, but hospital participation varies.
- If you live in a nursing home or an assisted-living facility and sign a DNR form, ask that a copy be kept on record. Residents who do not want to sign a DNR form should put their wishes in their official records, too.
- Emergency situations are more complicated. In some states, emergency response teams will accept verbal DNR orders from a family member, but most states require official documentation to withhold resuscitation outside of the hospital.
- Patients with signed DNR forms should keep a completed copy at home and might consider wearing an ID bracelet. Some family members who know that a loved one does not want to be resuscitated may delay calling 911 in an emergency. But bear in mind that hospital staff can determine if recovery is possible (e.g., recognize sudden cardiac arrest vs. a heart attack), and medical teams may be able to keep patients comfortable as they are dying.
In many instances, a DNR order is discussed with family members after a relative becomes incapacitated following an unforeseen event like an accident, heart attack, or stroke. If an advanced medical directive or living will does not designate a healthcare proxy or surrogate, a spouse or adult child can decide whether to sign a DNR form. But family members might not know what you want, or the emotional strain of the situation might keep family from acting on your wishes.
Bottom line:
Posted in Healthy Living on January 7, 2009
Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer
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