What does it mean to have a DNR order? And how do you know whether it will be executed at the proper time and in accordance with your wishes? In our experience, the answers to these questions—for both lawyers and laymen—can be murky.
Let’s start with the basics. “DNR” is, of course, an acronym for “Do Not Resuscitate.” And the title is apt—generally a DNR prohibits lifesaving interventions to resuscitate a patient when the patient’s heart stops beating. It’s a medical order that says: “For this patient, don’t intubate, don’t get the paddles out, don’t’ do CPR—let him go.” It can only be provided by a doctor for a patient, and it can also be made durable, meaning generally authoritative for any other medical practitioners that may serve the patient, even emergency medical personnel, provided they know about it.
If they don’t know about it though, what happens?
That’s a question we’ve had before, and we learned some interesting answers after reading this story a few weeks ago. To summarize some of our conclusions:
- Application of a DNR can require a significant amount of interpretation
- The history of the DNR offers insightful context for understanding current communication failures between patients and their doctors regarding the consequences of a DNR
- there is a strong bias towards resuscitation by emergency personnel, even when a patient has a durable DNR
Our basic takeaway is to encourage our clients to ask their doctors what the DNR will mean under some of the various circumstances mentioned in the article. Questions like: If I am having surgery, will the DNR be waived? Can the scope of the DNR be limited to only prohibit CPR, but allow for other types of resuscitation? Can we clarify whether, in a situation where the need for resuscitation isn’t caused by an underlying condition, but rather results from a treatment you are providing, you will still respect it?
Perhaps these are hard questions to raise, but we think most doctors would welcome the opportunity to help their patients better understand the decision they make when they request a DNR order. We know our clients would.
