A do not resuscitate (DNR) order is a document that lets emergency personnel know that you do not want to receive cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) if your breathing stops or if your heart stops beating. DNR orders are different from living wills in a number of ways. A living will is a legal document that states your wishes and beliefs about end of life care. A DNR order is a medical order which your doctor signs. Also, while a living will can be broader in scope, touching on organ donation, specific treatments, and requesting continuation of care, a DNR order only applies to stopping medical professionals from performing CPR and ACLS procedures. A DNR order does not have any instructions for other treatments, like pain medicine, other medicines, or nutrition. In general, DNR orders are for people who are very elderly or already critically ill, whereas everyone should get a living will. If you do not have a DNR order, emergency medical personnel are required to use all available measures, even those which are quite invasive, to save your life. This article will give some more information on what exactly a DNR order covers, how to get one, how to remove one, and the two main types of DNR orders.
What Does a DNR order cover?
As stated above, a DNR order specifically covers the denial of CPR and ACLS procedures. The specific procedures that are included in these categories are emergency procedures such as:
Electroshock to restart the heart
Insertion of Breathing tubes to open airways
Other forms of resuscitation, including certain medications
How to Get a DNR Order
All adults in NY and NJ can request a DNR order. There are two types of DNR orders. One type of DNR order is effective only in hospitals and nursing homes, and one type of DNR order is effective outside of a hospital. A hospital DNR is a note in your chart that lets the other hospital workers know your wishes. A non-hospital DNR is a form signed that you keep with you that an EMT finds, or that you or a surrogate shows to an EMT. Normally with a non-hospital DNR, you will wear a bracelet that alerts the medical technician to the existence of your DNR.
There are a number of ways to get a hospital DNR order:
You can request one yourself
You can use a living will that makes it clear that you would want a DNR order, and then your doctor can put the DNR on your chart for you when you become incapacitated.
If you have a health care proxy, your agent can authorize the DNR order for you.
If you have no advance directives, your appointed surrogate may be able to authorize a DNR order, if they believe it is what you would want.
To get a non-hospital DNR order, speak with your doctor. If they agree that a DNR order is appropriate for you, you can give them your state’s DNR form, though it is likely that your doctor will have a blank one to fill out and give to you.
How to Remove a DNR Order.
If you have capacity, it is quite easy to remove a DNR order. All you have to do is tell your doctor or health care team that you no longer want the DNR order, and then destroy any documents which contain the DNR order. If you are incapacitated, it becomes more complicated. If your doctor created a DNR for you before you became ill or injured, your family cannot override it. A health care proxy may be able to remove the DNR if they can show evidence that you changed your mind.
A DNR is a medical order that can be very valuable. CPR procedures do not always work properly, and it’s possible that the patient can end up with brain damage or on life support. Whether you are willing to accept this risk is a very personal decision. While it is a difficult thing to think about, it is often valuable to think about it now, rather than end up in a situation you don’t want to be in later. As with all advance directives, it is also very important to speak with your loved ones and let them know your wishes. Any advance directive is only useful if people know about it.
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