Do Not Resuscitate (DNR)

What does DNR mean?

A DNR states that your loved one does not want cardiopulmonary resuscitation (CPR) if their heart or breathing stops. This means that the DNR addresses two physical situations:

1. When the heart stops beating (cardiac arrest):
   • Resuscitation is done in an attempt to restart the heart and immediately get your loved one necessary medical care.
   • This is done using chest compressions or a defibrillator along with supportive breathing, like mouth-to-mouth.
2. When breathing stops:
   • They may have had a sudden stroke or choked on some food.
   • A person receives assisted breathing via mouth-to-mouth breathing or mechanical means, such as an air pump.
   • Breathing may need to be aided further with intubation, meaning a tube is inserted into the trachea (breathing tube) to keep it open.
   • Resuscitation in this situation still involves chest compressions or use of a defibrillator if there is no pulse.

How does a DNR order work?

A DNR is an order, just like one for getting a medication or seeing a therapist. It means that your loved one’s doctor has approved their request to not have CPR if their heart or breathing stops.

If no DNR is in place, emergency or hospital personnel will start CPR if a person’s heart or breathing stops.

Are there DNR pros and cons?

Making the decision of whether or not to be resuscitated may not be easy for your loved one. It is also one that can change with one’s stage of life or health. Consider these examples:

• Your loved one is healthy, active, and likely to live independently for several years or more.
• A person who has had a rapid health decline, including the onset of one or more serious illnesses.
• A young person who was injured and is now in a coma with little chance of recovery.

In each of those situations, your loved one, or you as a healthcare proxy, makes resuscitation decisions.

DNR pros include:

• Making a choice around a DNR order while your loved one is still in a good state of mind.
• Making sure the decision relieves loved ones of having to decide.
• Your loved one’s choice is clear to emergency and medical personnel.
• Your loved one can revoke the DNR order at any time.

DNR cons include:

• Arguments can arise if family members disagree about your loved one’s decision.
• A DNR for the community may not apply when your loved one is admitted to the hospital.
• Some sources suggest that having a DNR can cause risks and the potential for less care for patients.

Why does someone choose a do not resuscitate order?

People have different reasons for choosing a DNR. Here are examples of why your loved one may or may not choose one.

• A DNR is for your loved one if:
  • They want to make the decision, rather than leaving it to others.
  • They are nearing life’s end.
  • They have a serious or terminal illness and do not want CPR if their heart or breathing stops.
  • They are about to have surgery that includes life-threatening risks.

• A DNR is not for your loved one if:
  • They are unsure and trust others to make the right decision for them.
  • They are healthy, vital, and likely to live for many years.
  • They want to have CPR if their heart or breathing stops.

• Your loved one’s DNR order can be activated at any time and anywhere.
  • The need for resuscitation can happen out in the community where first responders come to the rescue.
  • A hospital will ask about resuscitation wishes when your loved one is admitted to the hospital. Resuscitation can happen when your loved one is at the hospital as either an in-patient or out-patient.
  • Because of events like these, your loved one’s DNR needs to be kept on hand when out and about.

How do you get a DNR order?

DNR order forms are available online for your loved one’s state. Because this is an order, the DNR can be put in place during a doctor’s visit.

There are specific steps your loved one will take to get and keep a DNR. These are:

• Speaking with their primary care doctor about what they want to have happen if their heart and/or breathing stop.
• Choosing to be resuscitated or to have the doctor sign a DNR.

Your loved one can change a DNR at any time if they decide they now want to be resuscitated.

• They must revoke the DNR by talking with their doctor.
• All DNR copies should be destroyed.
• An example is they are being admitted to the hospital for elective surgery.
  • The hospital is likely to ask your loved one about their resuscitation decision.
  • They can discuss it with hospital personnel and then make a choice.

What are the do not resuscitate guidelines?

DNR guidelines only refer to the need for CPR. They do not apply to other needs your loved one might have in an emergency, such as:

• Oxygen to help breathing.
• Care for trauma, including bleeding.
• Intravenous therapy to help fluid levels.
• Pain medication.

Things to Consider Before Making a DNR Decision

There are decisions your loved one will make as part of talking with their doctor about making a DNR order. It’s important that information is clearly presented. Points to think about ahead of time are:

• If your loved one’s heart stops, do they want to be revived, if possible?
  • This means they’ll have CPR and maybe breathing assistance.
  • They might be given medication to help start their heart.
  • There is the potential for harm to their brain if their heart has not been beating for several minutes. This varies based on a person’s age and health.
• Do they want to have CPR if their heart or breathing stops but they don’t want a tube put in their airway?
  • That would mean they tell the doctor they don’t want a DNR but they do want a DNI.
  • If this is the case, it’s important to know that intubation and being on a ventilator can help with recovering from pneumonia.
• There are questions to ask the doctor as part of making this important decision:
  • What are the chances of a full recovery after having CPR?
  • If not a full recovery, what might life be like after a cardiac arrest?
  • How long does it usually take for emergency help to arrive?
  • If your loved one needs a breathing tube, what’s the usual length of time one is needed?

Does each state have their own DNR laws?

Each state has laws and free order forms available online. Your loved one’s doctor is up-to-date with state laws and has forms available in their office.