Understanding DNR Orders
Do not resuscitate (DNR) orders tell hospital staff not to do potentially life-restoring measures, such as CPR, if you or your loved one's heart and lungs stop working. It allows a natural death. And it prevents health care staff from artificially reviving a person and placing them on life support. In many states, a DNR order also applies to staff outside the hospital. This includes in nursing homes and emergency medical services.
A DNR order must be written by a doctor. Or in some cases, certain other health care workers write it. It can only be done with the person’s or family’s consent. An advance medical directive is a form that lets a person plan ahead for the care they'd want if they no longer can express their wishes. If a person has not written an advance medical directive, their family will decide on a DNR with the help of the health care team.
The person can cancel a DNR order at any time. The health care team can answer questions about the DNR form. Have copies of a DNR form readily available so that your wishes can be faithfully followed.
Writing a DNR order
When might a DNR order be written? When the person’s health condition is such that CPR and other resuscitation methods are not anted. It could be in the case of cardiac arrest. This could be because the chance of successful resuscitation is very low. Or it could be because the care plan now focuses on comfort measures instead of life-sustaining measures. A DNR order might be used in cases of coma and terminal illness.
Irreversible coma
A person does not respond to sight, sound, or touch in a coma. The heart and lungs may be working, but brain function is badly damaged due to trauma or disease.
Terminal illness
In the last stages of heart disease, advanced dementia, AIDS, cancer, and other illnesses, some people don’t want to prolong their suffering. A person or their family may agree to a DNR order if recovery isn’t likely and quality of life is poor or getting worse.
DNR orders and hospice care
A hospice program can offer care during the final weeks of life. Hospice programs provide dignity, pain control, and comfort care in the home or at special facilities. Hospice does not provide aggressive treatment. In fact, a DNR order will likely be discussed before a person is admitted to hospice. A social worker or case manager may be able to help you arrange for hospice support.
Documenting end-of-life wishes
A person with a serious, life-limiting illness may wish to document their treatment wishes in addition to DNR orders. This is known as a POLST form or by different names. It depends on the state. It's meant to provide a portable medical order to help guide health care providers on the specific medical treatments a person wants during a medical emergency. It's meant to complement a DNR order, not replace it. Your doctor can tell you more and help you complete the forms. The form may be called one of these:
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MOLST (medical orders for life-sustaining treatment)
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POLST (physician orders for life-sustaining treatment)
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MOST (medical orders for scope of treatment)
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POST (physician orders for scope of treatment)
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TPOPP (transportable physician orders for patient preferences)