4 minute read

Do Not Resuscitate Guidelines: When are DNRs Appropriate?

DNRs can be a controversial topic in the medical world. Learn some helpful Do Not Resuscitate guidelines here to help you make the right decision.

Patrick Hicks

Patrick Hicks, @PatrickHicks

Head of Legal, Trust & Will

Medical staff and physicians will take any means necessary to revive you if your heart stops or you stop breathing. This is their oath and their job as medical professionals. However, there are certain instances in which you may not want this type of intervention. This is why certain individuals choose to establish a Do Not Resuscitate (DNR) order. Because it is a life and death matter, DNRs are a controversial topic. That’s why it can be tricky to know whether or not you should use a DNR, and when it would be deemed appropriate. We put together some Do Not Resuscitate guidelines to help you navigate this difficult decision. You will find some suggested scenarios and events when using a DNR could potentially be appropriate, and other helpful tips. 

What is a DNR?

A DNR is short for Do Not Resuscitate, a type of medical order that stops doctors and other medical staff from intervening if a patient were to go into respiratory or cardiac arrest. 

Any doctor or medical staff will attempt to save a patient’s life by default. Therefore, they will perform CPR or use an AED device as necessary. The only exceptions are when there is a DNR order, or in a case so severe that a doctor deems that nothing can be done.

By having a DNR order, the doctors will know that the patient does not want to be resuscitated, even when they are unable to communicate. DNRs go into a patient’s medical record, and they can also keep the DNR order form and/or wallet cards on their person. Hospitals will often mark DNR patients for easy identification with color-coded bracelets or anklets. For more information, visit our guide that answers the question, “What is a DNR Order?”

When Is a DNR Appropriate?

Making the decision to issue a DNR is never easy. It means that we are willfully instructing doctors to not to attempt to bring us back to life if we were to enter an end-of-life scenario. 

When a patient’s heart stops, or they stop breathing, medical staff will conduct emergency intervention unless they are told not to. Possible procedures include chest compressions (CPR), electroshock (AED), insertion of tubes to open air pathways, and mouth-to-mouth CPR. 

If you feel like these procedures sound aggressive and invasive, you’re right. They are absolutely called for when trying to save a life. However, there are cases in which these procedures are futile or they might result in a patient being worse off than how they started. There are some instances in which a DNR is appropriate, and family members and loved ones can have the opportunity to gather around and say goodbye. 

Here are some medical scenarios which may merit in issuing a DNR:

  • Terminal illness

  • Severe chronic disease

  • Permanently unconscious 

  • Severe dementia

  • Resuscitation efforts would be futile

  • Effects of CPR would leave patient in worse condition

Can a Person Write Their Own DNR? 

If you feel that you do not want to be resuscitated, you should communicate this to your doctor right away. They will likely present you with information and education along with their medical recommendations. If you choose to move forward, your physician will provide you with a DNR form. This form must be signed by you or your authorized health care agent if you are incapacitated. Depending on state law, the form may require two witness signatures or the signature of a notary public. Once the physician signs the form, they will put your DNR order in your medical chart. Moving forward, if you were to enter cardiac or respiratory arrest, medical staff and physicians should not attempt to resuscitate you. 

Other Helpful DNR Guidelines

Clarifying when DNR Orders Should Be Applied

So far, we have discussed how a DNR order may be appropriate in certain instances, such as when a patient has a terminal illness or chronic condition that cannot be improved. 

When a DNR order is issued, the outcome is clear-cut. It only goes into effect at the time of a patient’s death, and medical staff and doctors know not to attempt to resuscitate this patient. Signing the DNR order can be an easier decision when a patient knows what they do and do not want at the end of their life and understand that they have a terminal condition. 

Should Everyone Obtain A DNR?

The short answer is no. Some individuals are perfectly healthy, and have no idea what they would want to do if they were diagnosed with terminal cancer or other chronic disease. Others may have a chronic condition, but the outcomes are unknown and flexible. In the case of cardiac or respiratory arrest, resuscitation could be life-saving. In these cases, asking for a DNR form is likely not appropriate. DNRs should really only be on the table as an option if a patient faces an end-of-life scenario and is sure of what they’d want or not want.

Who Can Consent to a DNR Order?

If a patient is incapacitated and cannot consent to a DNR order themselves, a DNR order can still get approved. Although the rules vary from state to state, the patient’s health care agent can consent to the DNR order on their behalf. A family member or friend may be allowed to provide consent in egregious circumstances. Examples include if the patient has a terminal condition, is in a permanent coma, if CPR would be futile, or CPR would create added burden on the patient’s condition.

What is a POLST and does it conflict with a DNR order?

POLST stands for “Physicians orders for life-sustaining treatment,” and is used when a patient has been diagnosed with a terminal illness. It does not conflict with your DNR order, nor will it replace any other Advance Directives you may have in place. Your primary physician will fill out the POLST on your behalf; it will follow you such that you receive the medical care you want and need.

Is a DNR Right for Your Situation? 

Is a DNR right for your situation? Although we provided several Do Not Resuscitate guidelines in this guide for your information, requesting a DNR is a highly personal decision.

If you were to enter an end-of-life scenario, a DNR results in an outcome that cannot be taken back. When used inappropriately or in error, the outcome could be catastrophic. Remember that doctors and other medical staff have an oath to save lives whenever possible. If your heart were to stop beating or you were to stop breathing, they will do everything in their power to resuscitate you. If you do not want this, the only way to put a stop to this is with a DNR order. 

Only you can make this decision, and it should not be made lightly.

If you are healthy or are not sure about the outcome you would like, a great tool is an Advance Directive. These are estate planning documents that enable you to document your instructions for medical care and appoint a Durable Power of Attorney. A Durable Power of Attorney (or Medical Power of Attorney), is your legally-recognized health care agent who is authorized to make medical decisions on your behalf if you are impaired or incapacitated. They can also sign off on a DNR order if needed. 

Advance Directives are a great way to be proactive and make your medical wishes known today. They are also flexible in the sense that you can update your documents any time to make adjustments. Your values and beliefs may look different in the future, and it is your right to change your medical instructions. Further, you can always incorporate DNR order into your Advance Directive documents later on if you so choose. Want to learn more? We invite you to check out our Advance Directive page to find out what our package includes. 

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