I know that I don’t want machines to keep me alive for months or years if I am in a coma or vegetative state. And if I am at the end of my life, suffering with no chance of getting better, I don’t want radical medical interventions that will prolong my suffering. I am guessing that many of you share my desire. One might think that signing a Do Not Resuscitate (DNR) order will prevent this from occurring. However, it turns out that a DNR can potentially harm patients by leading doctors and nurses to provide less care, even when you are not in a coma or close to death. Unfortunately, many patients agree to a DNR without understanding what they are signing. Is a DNR a good idea for you?
What is the purpose of a DNR?
Patients (and sometimes family members) are routinely encouraged to sign a DNR when a patient is admitted to a hospital. A DNR order means if your heart stops or you can’t breathe, medical staff will let you die naturally, instead of giving you cardiopulmonary resuscitation (CPR) to restart your heart and/or breathing. Correctly interpreted, a DNR stops medical staff from performing just one procedure – CPR.
Should you be worried about CPR?
Most of us do not want to be kept alive with machinery. It’s natural to worry that CPR may save our life, but we’d be stuck with a life that we don’t want to live. However, research shows that when CPR is successful, patients can expect a relatively good quality of life. How well patients do after CPR is mostly determined by the age and medical condition of the patient before the CPR was administered.
How do doctors and nurses treat patients who have DNRs?
Medical staff often assume patients with DNRs are not interested in living. Research at top medical centers found that 46% of doctors misinterpret DNRs to mean patients want end of life or comfort care only. Many doctors and nurses withhold treatments that could sustain or cure a patient when there is a DNR in place. If you have a DNR in your chart, you may get less medical and nursing care throughout your stay. This could mean fewer tests like MRIs and CT scans, fewer medications, and even fewer bedside visits from your doctors. It can also prevent doctors from putting you in the ICU even when you need intensive care. Some experts feel the misuse of DNRs is a serious patient safety problem.
Simply put, a DNR could cost you your life.
How do DNRs impact patient outcomes?
Studies show that patients with DNRs have far worse recovery rates than patients with identical conditions and no DNRs. DNRs negatively impact women more than men.
- Hip fracture surgery patients with DNRs had mortality rates over two times greater than similar patients without DNRs. For the healthiest patients, the impact was even more extreme – having a DNR increased their risk of dying in the hospital from 3% to 17% – a fivefold increase.
- A study of patients hospitalized with acute myocardial infarction (the medical term for heart attack) found that patients with DNRs were significantly more likely to die during hospitalization than patients without DNRs (44% vs 5%).
- An analysis of California hospitals found that patients had higher death rates in hospitals that encourage DNRs.
Who should not have a DNR?
Importantly, don’t assume a DNR will apply only in extreme circumstances. Once it’s on your chart, medical staff will alter your care plan. If you think you are going to get out of the hospital and resume your life, a DNR is not for you!
Who needs a DNR?
People with terminal illnesses who are suffering are appropriate candidates for a DNR. Elderly patients who have serious medical conditions may also be good candidates. Patients without a terminal illness should not sign a DNR agreement without careful consideration.
How do you get a DNR?
A doctor writes the order for DNR, often when a patient is in the hospital. However, patients can also get a “pre-hospital” DNR, which can be helpful for very ill or elderly patients living at home or in skilled nursing facilities. Keep the DNR in a convenient place – perhaps on the fridge or at the front door. And make sure a copy is with the patient at all times when away from home.
Every state has their own requirements for DNRs. You can look into the rules for your state by searching online.
What should patients do?
Many patients sign DNR orders because they worry that something could happen that will leave them hooked up to machines for an indefinite amount of time. Although this is a valid concern, which no doubt many of us share, a DNR is not the answer.
Patients can, and should, create a living will (also referred to as an advanced directive). These legal documents outline what kind of care and treatment you want to receive. Learn more about living wills/advance directives, and consult your lawyer to help you create one.
In addition to a living will, you can create a video where you make your wishes clear. Research has found that doctors and nurses are more likely to understand and follow a patient’s wishes after viewing a patient’s testimonial video. You can make your own video with the help of the Institute of Healthcare Directives.
I urge you to read my post How to Get the Medical Care You Want. In this post, you’ll learn about healthcare proxies, POLSTs, and living wills, and how they compare to DNRs.