Advance Medical Directives: What is a DNR?


Legal Orders and Your Medical Care

An advance medical directive is a legal order that tells your doctor what kind of care you want when you are unable to make your wishes known to your doctor. For example, if you are in a coma, unconscious, or unable to fully communicate, an advance medical directive can give your doctor some direction in terms of making important decisions about your medical care.

1.   A DNR, or a do not resuscitate order, is one type of an advance medical directive. A DNR instructs your doctor that you do not wish to have cardiopulmonary resuscitation (CPR) performed if you stop breathing or your heart stops beating. If you don’t have a DNR in place, then your doctor and other medical professionals will perform CPR or take whatever steps are medically necessary to resuscitate you in an emergency situation.

2.   While the requirements for executing a DNR vary from state to state, all states have some provision allowing people to execute a DNR, which typically must be in writing, signed and dated, and signed by a witness. Please refer to this guide for patients and families. Many hospitals and medical facilities provide forms that you can sign to put a DNR in place. Lawyers also can prepare legal DNR documents and other advance medical directives according to your wishes.

What Types of Treatment does a DNR Encompass?

If you choose to execute a DNR, your physician also may ask whether you wish to have a do not intubate order. Intubation involves placing a tube through a person’s nose or mouth to reach his or her windpipe, or trachea, to help the person breathe when unable to do so on his or her own. In some states, intubation is included as part of a DNR order, so you must make your wishes clear if you want to distinguish between resuscitation and intubation in your DNR.

Another issue that may be addressed in a DNR in some cases is: artificial nutrition and hydration, which essentially delivers food and water to a person who can no longer take nourishment by mouth. Since this treatment is necessary to sustain life, it sometimes is affected by a DNR. Again, it is essential to make your wishes clear on this particular treatment so that your doctors act accordingly.

Based on your state, however, the law may restrict your ability to choose between different treatments in your DNR.

It is important to know that typically, a DNR should not affect treatments other than CPR or intubation. You should be able to continue to receive treatment such as chemotherapy, radiation, antibiotics, and dialysis as needed. If you choose to receive these types of treatments, it can be important to ensure your policy states you may stay in ICU. However, a DNR document may be more expansive depending on the laws of your state and the language contained within the document that you signed. This is why you must remember that you always have the option of changing your DNR. If at any time you change your mind about the treatment that you want to receive, you can do so.

However, once you are incapacitated and the doctor begins to carry out your wishes, it becomes nearly impossible to change your mind. Likewise, there is always the possibility that a doctor or hospital is unaware of your DNR, or that your doctor will not honor a DNR from another state. Unfortunately, a DNR is just a piece of paper, and does not always guarantee that your wishes are honored.

Advantages of a DNR

1.)   Having a DNR in place allows you to make important decisions about your medical care before you become seriously ill or injured.

2.)   A DNR lets your doctor know what you want to happen to you medically in certain circumstances and avoids delay in the case of important medical treatments that may require consent.

3.)   It also can take some difficult decisions and arguments away from your family members, who may disagree about these emotional and controversial issues. Having a DNR already established before you ever become sick or incapacitated may give you some peace of mind that these decisions are taken care of before such an event occurs.

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