In medical terms, DNR stands for Do-Not-Resuscitate. It is a medical order written by a health care provider that explicitly instructs medical professionals not to perform CPR (cardiopulmonary resuscitation) if a patient's breathing stops or their heart stops beating.
Understanding a DNR Order
A DNR order is a critical component of advance care planning, allowing individuals to express their wishes regarding life-sustaining medical treatments. It ensures that in the event of cardiac arrest or respiratory arrest, medical teams will respect the patient's decision to forgo aggressive resuscitation efforts.
- Core Instruction: The primary purpose of a DNR order is to prevent CPR. This includes chest compressions, artificial ventilation (breathing tubes), electrical shocks (defibrillation), and emergency cardiac medications.
- Who Issues It: A DNR order is a formal medical order written by a healthcare provider, such as a doctor, after discussion with the patient or their legally authorized decision-maker.
- Patient Autonomy: It reflects a patient's right to make choices about their own medical care, especially at the end of life. Patients or their surrogates may opt for a DNR if they are terminally ill, have a poor prognosis for recovery, or wish to prioritize comfort and dignity over potentially painful and invasive procedures that may not offer a meaningful benefit.
Why Patients Choose a DNR
Patients and their families may decide on a DNR order for various personal, medical, and ethical reasons. These often include:
- Terminal Illness: For individuals with an irreversible, advanced illness where resuscitation would only prolong suffering without improving the quality of life or outcome.
- Quality of Life: A desire to avoid interventions that could lead to a diminished quality of life, such as prolonged dependency on machines or severe brain damage.
- Personal Beliefs: Philosophical or religious convictions about the natural course of life and death.
- Pain and Discomfort: Awareness that CPR can be a physically traumatic procedure, especially for frail or elderly patients.
What a DNR Order Does NOT Mean
It's crucial to understand that a DNR order is specific to resuscitation and does not mean that all medical care is withheld. Patients with a DNR order will still receive:
- Comfort Care: Medications for pain, nausea, and other symptoms.
- Routine Medical Treatment: Treatment for treatable illnesses or conditions (e.g., antibiotics for an infection, oxygen for breathing difficulties).
- Palliative Care: Care focused on providing relief from the symptoms and stress of a serious illness, with the goal of improving quality of life for both the patient and their family.
Establishing a DNR Order
The process for establishing a DNR order typically involves:
- Discussion: A healthcare provider discusses the patient's prognosis, treatment options, and the potential outcomes of CPR with the patient and/or their family.
- Informed Consent: The patient (if competent) or their designated surrogate provides informed consent to the DNR order.
- Documentation: The order is formally documented in the patient's medical record. In some states, a specific form or bracelet (like a "Comfort Care" or "DNR" bracelet/necklace) is used to indicate the order outside of the hospital setting, for emergency medical services (EMS) personnel.
- Review: DNR orders can be reviewed and rescinded by the patient at any time if their wishes change.
For more detailed information on advance directives and end-of-life care, you can refer to resources from reputable organizations like the National Institute on Aging or the American Heart Association.
