Your loved one’s wishes during the final stage of life are important. There are a range of health, legal and moral considerations to keep in mind. In particular, your loved one’s quality of life during the end-of-life stage is a priority. A DNR is a big part of that comfort.
Some seniors may wish to forgo receiving CPR in the event of an emergency so that they may have a more peaceful end-of-life experience. The do-not-resuscitate order (DNR) is the legal document that allows them to do this.
Let’s go into depth about DNR orders, including how to create one and the pros/cons of having one in place.
What is a DNR?
A DNR is a do-not-resuscitate order. It’s sometimes referred to as “no code” or “allow natural death.” The idea behind a DNR is to choose whether you wish to receive cardiopulmonary resuscitation (CPR) in the event of an emergency. Having a DNR means that you forgo CPR, knowing that it may result in your death. A DNR doesn’t specify any treatment other than CPR.
What is CPR and how does it relate to DNR?
CPR involves “chest compressions to restore heart function, as well as mouth-to-mouth breathing to restore lung function.” It can be a life-saving medical action and is often used in emergency situations. According to the American Heart Association, CPR can double or triple chances of survival.
A DNR is an order to stop CPR from occurring under an emergency situation.
What are the risks of CPR for seniors?
CPR can save lives. However, seniors may refuse their right to this medical treatment for a variety of reasons.
To start, CPR is an intense procedure that attempts to restore breathing and heart function. Seniors – especially those with illness or injury – are especially fragile and may not respond to the forceful nature of CPR.
In particular, seniors with terminal illnesses such as cancer may not see any medical benefit of CPR. Instead, CPR may increase their risk of health problems and reduce quality of life in their final stage of life. For example, if CPR is performed on a terminally ill senior, it’s possible that the patient will suffer brain or organ damage, requiring the use of a breathing machine or other more invasive interventions.
Many seniors in this situation prefer to have a peaceful death, without the health risks of CPR. In this case, a DNR is essential. Having a DNR allows patients to forgo CPR and live their last days as they wish.
Does a DNR change other aspects of medical care?
It’s important to note that a DNR only refers to emergency CPR. Having a DNR won’t impact other medical care that you receive at a hospital, clinic, hospice or at home. It’s not a blanket refusal of all medical care.
Why might seniors want a DNR?
A DNR may be the right choice for seniors with terminal illnesses, especially if they’re in a hospice program. Because death is expected soon, receiving emergency CPR doesn’t make much sense.
In fact, under these circumstances, having a DNR is essential. If a patient doesn’t have a DNR in place, the end of life experience can be traumatic for the individual’s family – and not at all what the patient would have wanted.
For example, when a family calls 9-11 to report their loved one’s death or serious health event, the ambulance is legally obligated to perform life-saving actions, whenever possible. Instead of experiencing the peace of their loved one’s passing, the family may be shocked to see CPR performed.
It’s best to avoid this situation by having a DNR in place. In fact, your family should have a copy of the DNR at hand wherever your loved one is receiving treatment, whether at home, in hospice care or another facility.
Can I just tell emergency services not to perform CPR on my loved one?
No. While it may seem obvious to you that your loved one shouldn’t receive CPR, it’s not to emergency services. Moreover, you don’t have the legal authority to decide on the patient’s care. That’s why the legal documentation of a DNR is necessary to stop emergency services.
What if my loved one is in a hospice program?
Hospice programs have a plethora of advantages to maintain the patient’s quality of life. As part of these services, a DNR is often recommended and put in place according to the patient’s needs.
In addition, hospice nurses are legally able to declare death. So if your loved one is in hospice – whether at home or in a facility, you should call the hospice nurse instead of 911. He/she will declare death, without the need of emergency services.
Why might NOT a senior want a DNR?
Of course, the decision to have a DNR depends on the individual’s health and personal circumstances. There may be reasons why a patient doesn’t want a DNR. For example, if a senior is receiving treatment for an illness and retains the hope to live longer, a DNR may not be the right choice.
Moreover, there are diverse religious and personal beliefs surrounding death. A DNR may or may not be a part of an individual’s belief system.
In other words, while a DNR can be a good decision for terminally ill seniors who want a peaceful death, it may not be the right choice for everyone.
Creating and respecting a DNR
How is a DNR created?
A DNR is created by a licensed physician after discussing it with the patient. Often this is part of a hospice care plan, but it doesn’t have to be.
The doctor will write up the DNR order, add it to your hospital medical record and give you instructions on any DNR documentation you might need outside of the hospital (wallet card, bracelet, etc.). This depends greatly on your location, as every state has a slightly different system.
Is the DNR valid outside of the hospital?
You will need to request the DNR order to apply outside of the hospital. In addition, you’ll need to get the proper DNR documentation (order, wallet card, bracelet, etc.) for the DNR to be followed outside of the hospital.
What if I’m unable to state my wishes about DNR?
If you’re lost the capacity to make decisions, whether through illness or injury, your doctor will prioritize your wishes in the following way.
- First, if you previously requested a DNR and it’s current in place, this decision will remain.
- Next, if you have a living will, any instructions regarding DNR will be upheld.
- Finally, if you’ve legally named a health proxy, such as a family member, this person can decide about creating a DNR on your behalf.
However, if you don’t have a living will or a health proxy, creating a DNR can be more complicated. Often a close family member is consulted about your wishes in order to create a DNR.
What if I change my mind about a DNR?
You retain the right at all times to change your mind about a DNR. In the event of an emergency, you may request CPR.
If you’ve changed your mind before an emergency, discuss the DNR with your doctor. He/she must be involved to remove the DNR order. The same goes if you want to create a DNR order. Be sure to contact your doctor to get this taken care of.
Can my family change a DNR for me?
It’s a common misunderstanding that a family member can choose medical treatment for you. Legally, only you, a living will or a health proxy can make these decisions. Or, if you don’t have medical capacity to decide, a close family member will be consulted.
If you’ve already specified your wishes about DNR, your family can’t override them. This would only be possible if you named a health proxy to oversee your medical treatments.
What happens if a DNR isn’t followed?
A DNR is a legal document and must be followed according to the law. Sometimes DNRs aren’t followed outside the hospital because the family didn’t present the DNR or related documentation to stop emergency services. The DNR must be valid and visible for emergency teams to follow it.
For this reason, it’s important to have all the DNR paperwork handy – with a wallet card, etc. – so that mishaps like these don’t occur.
What are advanced health directives and why are they important?
Advanced health directives include legal instruments in which you’ve specified your wishes for medical treatment. A DNR is a good example of an advanced health directive, as is organ donation.
Regarding seniors, the two key advanced health directives include a living will and a health proxy (also called a medical power of attorney). A living will allows you to give instructions about your care while you’re alive and unable to state your wishes.
Likewise, a health proxy is somebody you can name to oversee your health care decisions if you’re unable to state your wishes. Often this is a close family member, such as a spouse or child.
End of life planning, such as a living will and/or a health proxy, is important to make sure your end of life experience goes according to your wishes.
In conclusion, the decision to have a DNR is based on both medical judgment and the patient’s wishes and values. If you want more information about DNRs – or senior health in general – check out MyCaringPlan. You’ll get lots of key information about senior health to guide you through the aging process.
- Do-not-resuscitate order, MedlinePlus, https://medlineplus.gov/ency/patientinstructions/000473.htm
- Advanced Care Directives, Brigham and Women’s Faulkner Hospital, https://www.brighamandwomensfaulkner.org/patients-and-families/advance-care-directives/dnr-orders
- Types of Advance Directives, Cancer.org, https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/advance-directives/types-of-advance-health-care-directives.html