A Do Not Resuscitate (DNR) order is a type of advance directive which indicates that a patient should not be offered CPR or other lifesaving measures in the event of cardiac arrest or other medical emergencies. Typically, a DNR is requested by or for a patient who is terminally ill, to avoid potentially painful and invasive procedures. Very elderly patients or patients in other circumstances may also request a DNR.
There are a number of types of DNR order, and it is helpful to know the difference between them, especially if you are considering a DNR request for yourself. While most people associate a DNR with cardiopulmonary resuscitation (CPR), other lifesaving measures including the administration of IV drugs, intubation to secure an airway, and use of defibrillator paddles may also be used in a hospital environment. Some of these measures are traumatic and invasive, and they may not always be effective, if a patient is seriously ill.
Under a basic DNR order, none of these measures will be provided to a patient who is in respiratory or cardiac arrest. However, hospital staff and nurses will still work to make the patient comfortable through the administration of oxygen, movement of the patient, and hydration with intravenous fluids. The intention of a DNR is not to kill a patient, but to keep him or her comfortable when death approaches.
Ideally, a patient should request a DNR with his or her doctor, setting up what is known as a “DNR specific.” This type of DNR is much more extensive, indicating specific desires for certain conditions. For example, a patient may request a DNR if he or she ends up in a coma, but not if he or she experiences a heart attack while awake. By being specific in an advanced directive, the patient can be sure that his or her wishes are followed in the event of a major medical catastrophe.
In a patient cannot make medical decisions and an advanced directive has not been dictated, someone else must take responsibility, such as a close relative or somehow in whom the parent has invested the power of attorney. People who are put in this position should think carefully about the wishes of the patient, especially if he or she is experiencing multiple organ failure or brain death. It may be helpful to remember than brain dead patients can potentially donate their organs, thereby saving lives even if they are no longer able to enjoy life.
