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What Does 'Do Not Resuscitate' Really Mean?

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We take a hard look at the various kinds of DNRs
and why they are a preferred choice for some.

It’s never easy when a senior loved one nears the end of life and sometimes difficult decisions need to be made regarding medical interventions, such as if they do or don’t want to be revived if their heart stops beating. Wishes to not be resuscitated can be legally recognized in a medical order, or advance directive, called a Do Not Resuscitate (DNR) order. We take a hard look at the various kinds of DNRs and why they are a preferred choice for some.

 

What does a DNR mean?

When an aging adult has a terminal illness or some other serious medical condition, they may decide not to have cardiopulmonary resuscitation (CPR) attempted in the event their heart or breathing stops. It tells the medical team that your senior loved one desires to die naturally without any additional measures of ventilation, intubation or vasopressor support. In many cases, a practicing physician writes a DNR order after thoroughly discussing the benefits and burdens of CPR with the patient (or surrogate decision maker). It is set up before an emergency occurs to instruct healthcare providers not to perform CPR.

 

Why would someone not want to be resuscitated?

Sometimes CPR only partially works and leaves a person with a beating heart but simultaneously brain-dead. The patient may need artificial breathing or be left in some other vegetative state. Sometimes people nearing the end of life, who are battling a deteriorating condition, are willing to let go when their body tells them it’s time.

 

Numerous methods of CPR involve more than chest compressions and mouth-to-mouth resuscitation. Powerful drugs, insertion of a breathing tube or an electric shock to jolt the heart back into beating again might occur. Sometimes a patient is resuscitated but may suffer painful injuries as a result including severe bruises and broken bones, especially if their body is already in a delicate condition. Even if CPR is effective, the heart and lungs may fail again.

 

What it doesn’t mean.

It does not mean “do not treat” if a condition arises where treatments such as antibiotics, oxygen or IV fluids would be beneficial.

 

Hospital care:

A DNR in a hospital may be called an “Allow Natural Death” order. Meaning if the patient is hospitalized and didn’t want staff to intervene if their heart or breathing stopped, staff would honor the wishes to die naturally. Some hospitals require a new DNR order each time of admission.

 

Outside of the hospital:

Here it’s slightly different. Some states have an advance directive called a Do Not Attempt Resuscitation (DNAR) or special Do Not Resuscitate (DNR) order for use outside hospital grounds. This type of non-hospital DNR or DNAR is intended for Emergency Media Technicians (EMT). Even though families expecting a death are sometimes advised to call for other services for help in an emergency, sometimes 911 is dialed at a time of uncertainty. Since EMTs are trained to revive and prolong life in every way they can, undesirable measures may be performed. A non-hospital DNR or DNAR allows patients to refuse full resuscitation efforts in advance and documents are still signed by both the patient and doctor.

 

A DNR can be changed later on

If your senior loved one is of sound mind, meaning they can still think rationally and communicate wishes in a clear manner, they may change their advance directive choices with their physician and sign and notarize them (according to individual state laws).

 

Patients have the legal and moral right to accept or refuse medical treatments as they wish. It’s important to discuss what your parents’ end-of-life wishes are and to thoroughly talk them through with family members and caring physicians.