Is a DNR a good idea? I know 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. You may think that signing a Do Not Resuscitate (DNR) order is a great idea since it will prevent this from occurring. However, it turns out that a DNR can potentially harm you (or a loved one) 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. Don’t make a hasty decision.
What is the purpose of a DNR?
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.
Signing a DNR does not mean you want to die. Instead, it means you do not want to be revived, or be kept alive through heroic measures. When you, or a loved one, are admitted to a hospital, staff may encourage you to sign a DNR. However, I recommend you do not blindly agree without understanding how a DNR can change the course of your care.
Should you worry about CPR?
When considering a DNR, it’s natural to be concerned that although CPR could save your life, it could leave you severely disabled or in a coma. Certainly, most, if not all, of us do not want to machines keeping us alive. 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 getting CPR.
How do doctors and nurses treat patients who have DNRs?
Medical staff often assume patients with DNRs are not interested in living. Importantly, many medical professionals do not understand the exact meaning of a DNR order, and thereby provide poorer care to patients with DNRs. In fact, in many hospitals, DNR may as well stand for DNT (do not treat).
For example, research at top medical centers found that 46% of doctors misinterpret DNRs to mean patients want “end of life” or comfort care only. Unfortunately, many doctors and nurses withhold treatments that could sustain or cure a patient when there is a DNR in place.
In other words, 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.
Moreover, a DNR 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 can DNRs harm patients?
Studies show that patients with DNRs have far worse recovery rates, and higher death rates, than patients with identical conditions and no DNRs. Interestingly, 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 higher death rates among heart failure patients in hospitals that encourage DNRs.
- A similar analysis found that among patients who suffered severe strokes, those treated at hospitals that encourage DNRs had a 13% increased risk of dying.
- A Harvard Medical School study found that among patients undergoing elective surgical procedures, the presence of a DNR increased the death rate in the 30-day postoperative period to 13.1% from 5.1%. Importantly, this increase in death rate was independent of patients’ baseline health.
- A study of patients who underwent emergency vascular surgery found that the presence of a DNR order was independently associated with mortality.
Who should not have a DNR?
Importantly, don’t assume it will apply only in extreme circumstances. Once it’s on your chart, medical staff will alter your care plan. Therefore, if you expect 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.
Importantly, 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, you can also get a “pre-hospital” DNR, which can help 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.
Importantly, if you sign a DNR, discuss your desires about treatments with your doctor. For example, if you want all types of possible care, except CPR, make your wishes known. Don’t assume your doctor, or doctors in your hospital, will correctly interpret the DNR.
Every state has their own requirements for DNRs. You can look into the rules for your state by searching online.
What should patients do instead of signing a DNR?
Many patients sign DNR orders because they don’t want to be connected 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 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.
I updated this post on 11-30-21.