Do Not Resuscitate Does Not Mean End of Care
Posted 11/28/2016 by UHBlog
What better time than the holiday season for families to discuss issues that are often put on the back burner, particularly those related to your loved ones’ end-of-life decisions? In Ohio, the do-not-resuscitate (DNR) order delineates people’s wishes about having cardiopulmonary resuscitation (CPR) if their heart stops and their breathing ceases.
“DNR orders are used by individuals who do not want aggressive resuscitative efforts made if they have a terminal illness, serious medical condition or wish to have a natural death,” says geriatric medicine specialist Taryn Lee, MD.
Some of the commonly asked questions that Dr. Lee's patients ask about a DNR order include:
Q. How do I get a DNR order?
A. A DNR order must be ordered and signed by one of these medical professionals: a physician, certified nurse practitioner (CNP), certified nurse specialist (CNS) or physician assistant (PA) who is in consultation with the individual or surrogate decision maker.
“Without a DNR order, emergency medical personnel must use all available measures, no matter how invasive, to revive you – even if there is no medical benefit expected,” says Dr. Lee. “Your DNR order should be in your medical file, on the refrigerator door, in your wallet or on a wristband. Your family or caregiver should be able to provide DNR documentation immediately, otherwise EMS must begin CPR.”
Q. Does a DNR order mean do not treat?
A. No, a DNR order doesn’t mean end of care. It means that resuscitative measures will not be used. Treatment that keeps the person free of pain and comfortable would always be given.
In Ohio, once the DNR protocol is activated, the health care provider will do any and/or all of these measures to keep your loved one comfortable, including:
- Suctioning the airway
- Administering oxygen
- Positioning the person for comfort
- Splinting or immobilizing
- Controlling bleeding
- Providing pain medication
- Providing emotional support
- Contacting other providers, such as hospice, home health, attending physicians, CNP, CNS and/or PA
However, the health care provider will not take these CPR measures:
- Administering chest compressions
- Inserting an artificial airway
- Administering resuscitative drugs
- Providing respiratory assistance (other than listed above)
- Initiating a resuscitative IV
- Initiating cardiac monitoring
Q. What is difference between DNR Comfort Care (DNRCC) and DNR Comfort Care–Arrest (DNRCC-Arrest)?
A. Ohio law recognizes two standard categories of DNR orders: DNRCC and DNRCC-Arrest. Both orders acknowledge a person’s right to choose not to receive CPR.
DNRCC is requested when a terminally ill patient wishes no medical treatment other than that which provides comfort or relief of symptoms.
DNRCC--Arrest is requested by a patient who wants all measure of medical care to sustain life, up to the time that resuscitation is needed and then CPR is not initiated.
Q. If I have a living will do I need a DNR?
A. Yes, you still do. A living will spells out your wishes about end-of-life care, but it's not a DNR order. For people who live in the community (home, assisted living, nursing home, etc.), a signed DNR form should be readily available for caregivers and emergency personnel to review. For hospitalized patients, a DNR order is entered by the medical professional once this wish is confirmed with the patient or surrogate.
Q. Can I change my mind and rescind my DNR order?
A. “People have the right to change their mind about the administration of CPR,” says Dr. Lee. “If you want to revoke the DNR order, you must talk to your physician right away and tell your family members about your decision.”
Q. If I'm too ill to consent to a DNR order, can someone else do it for me?
A. If you’re terminally ill and unable to express your DNR wishes, but have a living will that makes your end-of-life wishes clear, a doctor can put a DNR order in place.
“If you have no documents expressing your wishes, then an authorized surrogate like a spouse or close relative can authorize a DNR order, if they believe that is what you want,” she says. “But it would be much easier on family members if the form was completed in advance.”
You can download the DNR Comfort Care form by going to http://www.odh.ohio.gov/pdf/forms/dnrfrm.pdf. This form must be signed by a medical professional.
Taryn Lee, MD is a geriatrics medicine specialist and the Geriatrics Fellowship program director at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Lee or any other doctor online.