As medical professionals, we make difficult decisions every day. Among the most challenging decisions that face doctors and nurses are those that concern the end of a person’s life. Death is a natural thing, and it’s something that every human being must face and accept. When someone’s life is in your hands, it can be difficult to make decisions about things like resuscitation and life support.
A Do Not Resuscitate, or DNR, is an important way for people to make decisions ahead of time about their wishes regarding the end of their lives. It’s undeniable that when someone is kept alive through means like life support and artificial respiration, it can affect the quality of the rest of their lives. Rather than be kept alive artificially, while being unable to truly live, many people opt for a DNR instead.
For nurses, it’s very important to understand the legal aspects of a DNR. Here are all the basics you need to know about what a DNR is, what it does, and how it influences decisions regarding medical care.
Understanding What a DNR Means
A DNR consists of written instructions that tell healthcare professionals not to perform cardiopulmonary resuscitation (CPR). CPR is not always successful, especially in ill patients with cancer, widespread infections, or other severe health problems. During a medical emergency that arises suddenly, the person’s living will or individual with power of attorney may not be immediately available. For that reason, both the patient (or a surrogate) and their physician can sign an out-of-hospital DNR order. To signal other medical workers, the patient may wear a bracelet or have a brightly colored form that’s kept near them.
While DNR instructs medical professionals not to perform CPR, it does not preclude other life-saving treatments like antibiotic administration. It also does not prevent measures taken in the interest of pain management.
Creating a DNR
To create a DNR order, a patient or someone with power of attorney will need to talk to the patient’s physician. If for some reason, the physician does not want to carry out the DNR request, they may refer the patient to a physician, who will.
Then, the physician fills out a form, and adds a DNR order to the patient’s chart. The patient will be able to obtain a bracelet, wallet card, or other items and documents that will inform healthcare workers of the DNR. The DNR should also be included in the patient’s living will.
If a patient is unable to make a decision on their own, but has previously requested a DNR order, their family may not override it. However, family members with power of attorney may request a DNR order.
The POLST Process: An Enhanced Approach to DNR
In recent years, many states are beginning to adopt versions of a program known as Physician Orders for Life-Sustaining Treatment (POLST). POLST programs follow a common paradigm, but can vary from state to state.
POLST was developed to improve patient care by creating a clearer system to identify patients’ wishes regarding their treatment. It was created in response to the fact that advance directives alone are not always sufficient to ensure that chronically ill patients have their wishes honored.
POLST revolves around discussions ahead of time between patients, their loved ones, and their physicians. Once patients are informed about their treatment options and have made their decision, the physician will help them complete a POLST form based on their treatment preferences.
POLST is not an advance directive, but an actionable medical order. It is best suited to patients with conditions that are expected to become fatal within a year. POLST does not supplant an advance directive, but is designed to complement it.
Complying with a Patient’s End of Life Wishes
Although DNRs are quite common, there is sometimes a problem with physicians not following them. After all, the role of physicians and nurses is primarily to heal. Being unable to prolong someone’s life can be frustrating. But at the same time, everyone’s life must someday end, and there’s genuine value in preventing a terminally ill patient from being subjected to more suffering and pain because their life was artificially prolonged.