Having recently watched my father pass was a horrible experience. My father had been in nursing home care for about a year, and we watched him steadily decline. My family tried everything we could to keep his health robust and provide any medical services that could help make him more comfortable and prolong his life. As his health declined, we had to assess what services/medications to keep going for him and which to let go as his condition would not improve and they were unnecessary.
My father had a DNR in his heath care directive. The staff was bound to follow his requests. As we watched during his last month, we realized that a DNR does NOT work the way many think.
Many people think they don’t want machines to keep them alive for months or years if they are in a coma or vegetative state. And, at the end of life, and suffering with no chance of getting better, some people won’t want radical medical interventions that will prolong suffering.
Generally, people think that signing a Do Not Resuscitate (DNR) order is a great idea since it will prevent this from occurring. However, it turns out that a DNR can potentially harm you (or a loved one) by leading doctors and nurses to provide less care, even when you are not in a coma or close to death.
Unfortunately, many patients agree to a DNR without understanding what they are signing. Don’t make a hasty decision!
What is the purpose of a DNR?
A DNR order means if your heart stops or you can’t breathe, medical staff will let you die naturally, instead of giving you cardiopulmonary resuscitation (CPR) to restart your heart and/or breathing. Correctly interpreted, a DNR stops medical staff from performing just one procedure – CPR.
Signing a DNR does not mean you want to die. Instead, it means you do not want to be revived, or be kept alive through heroic measures. When you, or a loved one, are admitted to a hospital, staff may encourage you to sign a DNR.
When considering a DNR, it’s natural to be concerned that although CPR could save your life, it could leave you severely disabled or in a coma. Certainly, most, if not all, of us do not want machines keeping us alive. However, research shows that when CPR is successful, patients can expect a relatively good quality of life.
How well patients do after CPR is mostly determined by the age and medical condition of the patient before getting CPR.
How do doctors and nurses treat patients who have DNRs?
Medical staff can assume patients with DNRs are not interested in living. Importantly, many medical professionals do not understand the exact meaning of a DNR order, and thereby provide poorer care to patients with DNRs. In fact, in many hospitals, a DNR can stand for DNT (do not treat).
This was the experience my father had. We watched him suffer and slowly die a painful death as he had stopped eating or drinking. He had no other health conditions so essentially, he starved/dehydrated himself to death. The staff administered morphine to make him more comfortable, but otherwise, they were hands off in terms of any care.
If you have a DNR in your chart, you may get less medical and nursing care throughout your stay. This could mean fewer tests like MRIs and CT scans, fewer medications, and even fewer bedside visits from your doctors.
Moreover, a DNR can also prevent doctors from putting you in the ICU even when you need intensive care. Simply put, a DNR could cost you your life.
How can DNRs harm patients?
Studies show that patients with DNRs have worse recovery rates and higher death rates, than patients with identical conditions and no DNRs. Interestingly, DNRs negatively impact women more than men.
Some findings:
- Hip fracture surgery patients with DNRs had mortality rates over 2x greater than similar patients without DNRs. For the healthiest patients, the impact was even more extreme – having a DNR increased their risk of dying in the hospital from 3% to 17% – a fivefold increase.
- A study of patients hospitalized with acute myocardial infarction (the medical term for heart attack) found that patients with DNRs were significantly more likely to die during hospitalization than patients without DNRs (44% vs 5%).
Who should not have a DNR?
Importantly, don’t assume it will apply only in extreme circumstances. Once it’s on your chart, medical staff will alter your care plan. Therefore, if you expect to get out of the hospital and resume your life, a DNR may not be for you!
Who needs a DNR?
People with terminal illnesses who are suffering are appropriate candidates for a DNR. Elderly patients who have serious medical conditions may also be good candidates.
Importantly, patients without a terminal illness should not sign a DNR agreement without careful consideration.
How do you get a DNR?
A doctor writes the order for DNR, often when a patient is in the hospital. However, you can also get a “pre-hospital” DNR, which can help very ill or elderly patients living at home or in skilled nursing facilities.
Keep the DNR in a convenient place – perhaps on the fridge or at the front door. And make sure a copy is with the patient at all times when away from home.
Importantly, if you sign a DNR, discuss your desires about treatments with your doctor. For example, if you want all types of possible care, except CPR, make your wishes known. Don’t assume your doctor, or doctors in your hospital, will correctly interpret the DNR. Note – Every state has their own requirements for DNRs.
What should patients do instead of signing a DNR?
Many patients sign DNR orders because they don’t want to be connected to machines for an indefinite amount of time. Although this is a valid concern, which no doubt many of us share, a DNR is not the answer.
Patients can, and should, create a living will (also referred to as an advanced directive). These legal documents outline what kind of care and treatment you want to receive.