The Resuscitation Question

In my previous post, I started a blog series in order to more closely examine the estate planning documents every person should have; I began by investigating the difference between the living will and the last will and testament. This post, the second in the series, will address the delicate subject of resuscitation, specifically focusing on the “Do Not Resuscitate” (DNR) form.

This subject can be very sensitive, but the necessity for clear communication is monumental. It’s far better for you to know what your loved one wants done before there is an emergency and you are forced into the extremely difficult position of having to make that decision for them.

What is a DNR Form?

The DNR form is a medical order written by a doctor directing medical personnel to not perform cardiopulmonary resuscitation (CPR) if a patient stops breathing or if their heart stops beating. In short, it authorizes the health care professionals to stand down and allow the situation to run its natural course. The doctor will only write a DNR order after talking it over with a conscious and/or cognizant patient or that patient’s representative (i.e., the person who has Power of Attorney—a topic I’ll cover in the next blogpost), or with the patient’s family.

A similar but lesser-known order, the “Do Not Intubate” (DNI) form can also be authorized by a physician. It states that if a patient stops breathing, a tube is not to be inserted into the patient’s airway to help with breathing; however, chest compressions (CPR) may still be performed unless there is also a DNR order for the patient.

When is a DNR Order Appropriate?

If a patient is near the end of their life, as in the case of an illness that will never get better, that person (or their representative) can make the decision to sign the DNR order prepared by their physician. It is not required to have a DNR on file, but without it the medical staff will be compelled to perform CPR in an emergency.

When my grandparents were admitted to their nursing home, the social worker was required to ask me if I would want them to be resuscitated. The implication of the question brought me to tears, but thankfully I knew the answer because I had talked with both of my grandparents well ahead of the question being asked. For Edward and Clara Meade, the answer was a resounding “No; Do Not Resuscitate!”

When Would a DNR be Utilized?

It is important to note that a DNR only goes into effect if the patient’s heart stops beating or if they stop breathing.

Do You Have to be Elderly or Ill to Have a DNR?

Anyone at any age can have a DNR created, but it is generally accepted that it’s better used with frail, elderly or terminally ill patients who would not be likely to benefit from being resuscitated.

Be Specific with Medical Professionals

If you have medical power of attorney for your loved one, you need to understand the importance of being very clear about the goal; medical personnel must have a well-defined directive in a life-and-death emergency.

A good friend of mine recently had a loved one in the hospital; she expressed frustration because the medical staff continued to ask if the family wanted him resuscitated if his heart or breathing stopped. Her family had instructed the physicians to do chest compressions (CPR) if he experienced cardiac arrest, but they also said they didn’t want him intubated. I explained that the medical staff was going to continue to ask about it because they had no clarity. Her family had verbally given them conflicting information, and there was no DNR in place; in essence, they were saying, “Save his life, but don’t save his life.” Once the family clarified “Do Not Resuscitate,” the physician’s written order was placed in his file, and within a few days he passed quietly in his sleep.

While the phrase “Do Not Resuscitate” has been shorted to simply DNR, the weight of those three little letters cannot be underestimated. For this reason, I encourage everyone to have that discussion to properly and clearly express what they do or do not want done in the name of life-saving actions. For more information about the DNR and DNI orders, schedule a consultation with your physician.