Comprehensive Guide to Do Not Resuscitate Orders
If you are an older individual, or is you are the adult child of an elderly mother or father, you may be considering a do not resuscitate order. You may be considering this type of legal instrument, but also may not be certain what is entailed in a do not resuscitate order. Through this article, we provide a comprehensive guide to a do not resuscitate order.
Definition of a Do Not Resuscitate Order
A do not resuscitate order is a formal medical directive that a patient can establish with his or her doctor or other medical providers. A do not resuscitate order dictates that the patient does not wish to receive CPR or have their heart restarted in the event that their heart stops. The order does not affect other life prolonging measures such as a feeding tube. As the name of the directive indicates, this order applies only to resuscitation.
A do not resuscitate order must be written or prepared by a doctor. The doctor will typically explain your options to you and your family, outlining what the do not resuscitate order includes. With your voluntary consent, the doctor will create the do not resuscitate order. The do not resuscitate order will then be made a part of your medical record. In this digital age, the do not resuscitate order will then be visible and applicable to any medical professionals who treat you.
While the purpose of a do not resuscitate order is to advise medical personnel, it can be used outside of a clinical setting. By way of explanation, a person may have something like a do not resuscitate order tattoo or bracelet. This is intended to prevent bystanders from aiding them outside of the hospital.
In addition, nursing homes, assisted living communities, and other long-term care facilities will sometimes maintain do not resuscitate orders for the people in their care or in their facilities.
Reasons Why a Person Elects to Have a Do Not Resuscitate Order
Up to four out of five people receiving end of life care are opposed to the use of aggressive or extraordinary lifesaving measures. While procedures like CPR and defibrillation can be highly effective for relatively healthy people, they don’t significantly prolong the lives of people who are already terminally ill or receiving end of life care. For these women and men, lifesaving measures can actually be a painful hindrance.
When these measures do work in the short term, they can further compromise the patient’s quality of life in the not too distant future and for the long term as well. For example, some frail patients may suffer brain or other type of organ damage when aggressive lifesaving measures are taken.
Examples of when a patient might elect to have do not resuscitate order include:
- Resuscitation is unlikely to be successful
- Resuscitation is unlikely to prolong the patient’s life for very long
- Resuscitation could endanger the patient’s quality of life
- The patient has a terminal illness and does not expect to live for much longer
To put it in its simplest terms, a do not resuscitate order allows a patient to say “I just want to let nature take its course and do not want to resuscitated.”
A Healthy Individual Can Obtain a Do Not Resuscitate Order
A do not resuscitate order oftentimes is sought by aging or terminally ill individuals. A do not resuscitate order is also suitable for a healthy person in some instances. The reality is that many physicians have do not resuscitate orders in place.
While most states do allow any adult to create a do not resuscitate order, doing so is not always a good idea. If you don’t meet any of the criteria listed above, you may be putting yourself at risk of facing a preventable death when effective interventions are available to you.
Some people will request a do not resuscitate order because they believe that resuscitation isn’t effective or that it does more harm than good. While it’s true that over 90 percent of out-of-hospital cardiac arrests are fatal, this is largely due to a lack of intervention and not because of intervention itself, not because of the resuscitation process.
When CPR is used in conjunction with an automated external defibrillator, a patient’s chances of survival can increase by upwards to five times. The key to success is rapid intervention. Rapid intervention for otherwise healthy individuals can mean many more years of life.
Other Types of End of Life Orders Available in the United States
A do not resuscitate order is not the only type of order associated with end of life issues. There are other types of end of life orders available in the United States.
Do Not Resuscitate Order Versus Living Will
A do not resuscitate order is not the same as a living will, also known as an advanced medical directive. A do not resuscitate order is more limited. On the other hand, a living will covers a wide range of extraordinary medical interventions in the event of a medial emergency. These include:
- Ventilators
- Feeding tubes
- Blood transfusions
- Dialysis
- Other interventions
Living wills are created by both healthy as well as ailing individuals. They are designed to take effect if a person cannot express his or her wishes in the midst of a medical emergency. Generally speaking, a living will does not cover resuscitation. In other words, if person wanted to cover the full spectrum of issues discussed in this paragraph, both instruments would be needed.
Do Not Resuscitate Order Versus Do Not Intubate Order
A do not resuscitate order prohibits doctors from resuscitating a stopped heart. On the other hand, a do not intubate prohibits doctors from inserting a breathing tube to prolong an individual’s life. A do not intubate does not apply to resuscitation.
For an ailing patient who wants to bar all aggressive life-saving measures, it may be advisable to establish both a do not resuscitate order and a do not intubate. A do not resuscitate order covers cardiac arrest while a do not intubate covers respiratory failure and associated conditions.
Do Not Resuscitate Order Versus Allow Natural Death Order
An allow natural death order is used by certain hospitals in place of a traditional do not resuscitate order. Whereas the classic do not resuscitate order disallows all attempts to revive a patient with no heartbeat, an allow natural death order more specifically dictates that medical personnel should only use comfort measures to control pain and other symptoms.
For instance, an allow natural death order may permit doctors to withhold resuscitations, intubations, and any other treatments that only serve to prolong the person’s life without preserving the quality of life. In many cases, it can serve the purposes of a DNR, a DNI, and a living will, as it’s strictly concerned with ensuring the patient’s comfort while allowing nature to take its course.
Can a Do Not Resuscitate Order Be Overridden by Family Members?
As a general rule, a do not resuscitate order cannot be overridden by family members. The whole purpose of a do not resuscitate order is to allow the patient to make this important decision while conscious, calm, and of sound mind. Such a decision is designed so that it cannot be reversed without the person’s consent.
The only exception is a situation in which a do not resuscitate order was requested by an individual that also authorized another individual to make medical decisions on his or her behalf through a durable power of attorney for healthcare.
How to Get a Do Not Resuscitate Order
You can obtain a do not resuscitate order by scheduling an appointment with your primary care provider. When you obtain a do not resuscitate order, you will want to advise your family that this is now in place. You will also want to obtain appropriate identifying documentation to have on you so that other people will be alerted to the existence of a do not resuscitate order.