Kate Raphael’s New York Times article, What is a DNR Order and Should You Get One?, offers an excellent education for all of us. DNR stands for Do Not Resuscitate. This order needs to be initiated by the patient or the patient’s health proxy; it is essential knowledge for consumers. This patient order instructs workers in and outside a hospital not to restart your heart if it stops. So, the order prohibits CPR and associated resuscitation measures like electric shock to the heart, intubation, ventilation, and certain medications.
This prohibition is an unnatural act for health professionals and frankly for patients/families as
well. So why might someone want a DNR? This quote from the offers a wise response.
In many cases, if you are sick or frail, the harms of CPR “significantly outweigh the benefits,” said Mathew Pauley, a bioethicist at the Kaiser Permanente hospital system in California. Even if CPR revives you, which research shows is unlikely, chest compressions and shocks can cause debilitating injuries like broken bones, punctured lungs, and burns. Some who survive CPR have lasting cognitive impairments because of oxygen deprivation.
As the article states, "People with DNRs tend to be older adults with severe health conditions. In a 2011 study in Canada, some DNR patients wanted to avoid resuscitation because their quality of life was already low or because they feared resuscitation would lower it even more. Others wanted to minimize the emotional and financial burden on their families and the costs to society. Some DNR patients said they wanted to die naturally when their time came.”
Because DNR orders seem drastic, particularly to health professionals, they are often not followed for various reasons/excuses. So, making your DNR order a reality requires persistent communication. One way to communicate your preferences is to have your patient-directed order converted into a physician order. This conversion is called “physician orders for life-sustaining treatment” (POLST). Getting a physician to make this order is a
powerful form of communication and carries more weight with other health professionals. The POLST order is also more precise for health professionals to follow.
A few key points: CPR seldom works for frail elderly patients but is often used. The DNR and POLST orders can be changed at any time. These orders frequently avoid unnecessary suffering for patients and families.
More detailed information on this topic is covered in my book, The Journey’s End, and is available on my website.
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