Over the last decade I have had many clients request that I prepare a Do Not Resuscitate Order (DNR) for their signature. However, contrary to the understanding of most clients, a DNR is a medical order entered into the patient’s medical record that requires the consent and signature of a physician as well as the patient. Under New York law, any adult patient can request a DNR.
Generally, a DNR is executed when an individual has a history of chronic disease or terminal illness, such as chronic lung disease or heart disease, that has in the past or may in the future necessitate cardiopulmonary resuscitation (CPR), and the patient no longer wishes to be revived because of concerns that the use of CPR may not be successful, and may result in the patient being brain damaged or impaired.
If a DNR is in the patient’s medical chart, the medical staff is instructed not to try to revive a patient if breathing or heartbeat has stopped. Thus, physicians, nurses, and others are not to initiate emergency procedures such as chest compression, mouth-to-mouth resuscitation, electroshock, insertion of tube to open airways, and other forms of resuscitation.
If the patient is a resident of a nursing home, the DNR instructs the staff not to perform resuscitation.
It should be noted that merely because one requests that his or her physician enters a DNR order, that said doctor is not bound to enter the order in your chart if he or she does not believe it is appropriate. If the physician does not believe it should be entered on your chart, the physician must transfer the patient’s care to another physician, refer the matter to a dispute mediation in the hospital or nursing home.
If a patient is unable to consent to a DNR order because he or she is unable to decide for himself or herself, a family member or friend can consent if (a) the patient has a terminal condition; or (b) is permanently unconscious; or (c) CPR would be medically futile; or (d) CPR would impose an extraordinary burden given the patient’s medical condition and the expected outcome of CPR. The person deciding on the patient’s behalf must know the wishes of the patient.
If after a DNR order has been entered on a patient’s chart and the patient decides that he or she no longer wishes to have it, it can be withdrawn.
While a DNR serves as a valuable instrument for those with severe chronic and terminal illnesses, its effective implementation, especially in a non-nursing home or hospital setting, has been difficult, particularly when emergency medical services (EMS) are contacted because someone has stopped breathing. Even when a DNR order has been presented when EMS arrives, issues and disputes have arisen as to the administration of emergency CPR procedures.