For some medical conditions such as terminal cancer, end-stage renal disease, or severe pneumonia, life saving intervention is not warranted when patients stop breathing or when their hearts stop beating. A valid do not resuscitate order (DNR) tells medical professionals not to perform cardiopulmonary resuscitation (CPR) on a patient. DNR orders prove to be beneficial in preventing unnecessary or unwanted treatment at the end of an individual's life.
Patient DNR Requests
Competent, adult patients can request a DNR order themselves. Patient requests can be made orally to a physician, or in writing in the form of a living will or advance directive prior to becoming ill
Family DNR Requests
State laws vary as to whether hospitals are required to comply with advance directives. If a patient has designated a health care proxy, that person can request a DNR order. If a patient is too sick to request a DNR order for him or herself and no advance decisions have been made, the patient's family can request one. A family member's request will be honored if the patient is terminally ill or permanently unconscious or if a physician has determined that CPR would be medically futile or that CPR would impose an unnecessary burden on the patient given the individual's stage in life. If a patient's physician disagrees with the patient's request for a DNR order, the physician should transfer the patient to the care of a physician who agrees with the order.
Physician DNR Requests
Physicians can also enter DNR orders for their patients when it is determined that there would be no medical benefit to administering CPR. Physicians must discuss the DNR order with the patient or the patient's family as long as there is time to do so. Many hospital policies require that two doctors concur on a decision to enter a DNR if the patient is unable to consent to the order.
Other Medical Procedures and Care
Other therapeutic interventions, including transferring the patient to an intensive care unit, having blood cultures drawn, undergoing central lines placement, and receiving blood transfusions should not be influenced; DNR orders only preclude resuscitative efforts.
Revoking and Revising DNR Orders
DNR orders should be reviewed periodically and revised if appropriate. Also, patients can elect to revoke DNR orders. If there is doubt about the status of a patient's DNR order, medical personnel should attempt resuscitation.
Questions for your Attorney
- How is a DNR order revoked?
- Can I be an organ donor and have a DNR order?
- What happens if resuscitative measures are taken despite a DNR order?