THE ABC’S of a DNR
*By Anthony J. Enea Esq.
Do Not Resuscitate Orders (DNRs) are often confused with a different advance directive known as a Health Care Proxy (HCP). A HCP allows you to select someone to make health care decisions for you when you are no longer able to do so yourself. You can either give the agent you select specific written instructions as to your health care wishes and end of life wishes within the HCP or you can give them to your agent verbally
The HCP is generally prepared as part of one’s estate plan by an attorney or it is often given to a patient at the time of admission to the hospital if the patient is competent. An HCP must be signed and dated by the person making the appointment of an agent and must be witnessed by two disinterested individuals over the age of eighteen.
Unlike the HCP, a DNR is a medical order written by the patient’s doctor or a health care provider. It advises all health care providers that the patient does not want Cardiopulmonary Resuscitation (CPR) if their breathing has stopped. Patients that sign DNRs are generally those that have chronic illnesses, for example, Chronic Obstructive Pulmonary Disorder (COPD) and are prone to pneumonias and respiratory failure, thus requiring resuscitation.
Additionally, a patient that signs a DNR is often one that has already experienced the need to be resuscitated and no longer wishes to be kept alive by CPR. This also often occurs when one believes they are at the end of life and have given up the will to live.
The health care provider/doctor will only write the do not resuscitate order after a discussion with the patient (if mentally competent) and if the patient is not competent, with the patient’s health care agent or the family of the patient, depending on the circumstance.
From my own personal experience, I can assure you that the decision to sign a DNR on behalf of a loved one is daunting and traumatic.
It is also important to understand that a fully executed DNR will instruct all health care providers not to (a) perform mouth to mouth resuscitation on the patient; (b) utilize electronic shock to restart the heart (a defibrillator); (c) insert breathing tubes into the patient (use a ventilator) and offer to administer any medications to the patient that will restart breathing.
The patient’s decision to sign a DNR should be made with full knowledge of one’s medical condition and of the patient’s medical diagnosis and prognosis. It is clearly a document that requires significant consideration and should be discussed with one’s family members and named agent and contingent agent in the HCP.
The DNR can be printed in wallet size or can be part of a medical bracelet. It also should be prominently displayed in one’s home so that any emergency medical personnel/EMT can see it upon entering the patient’s home. In a hospital setting the DNR will be part of the patient’s medical records.
A document that works well with the DNR is a Living Will. It allows the patient to state that they do not want to be kept alive by extraordinary circumstances if they are brain dead, comatose with no hope of recovery.
Finally, while your attorney can prepare many advanced directives for you, such as a HCP, Living Will, Power of Attorney or HIPPA form, they can not prepare a DNR for you.
* Anthony J. Enea is the managing attorney of Enea, Scanlan and Sirignano, LLP of White Plains, New York. He focuses his practice on Wills, Trusts, Estates and Elder Law. Anthony is the Past Chair of the Elder Law and Special Needs Section of the New York State Bar Association (NYSBA), and is the past Chair of the 50+ Section of the NYSBA. He is a Past President and Founding member of the New York Chapter of the National Academy of Elder Law Attorneys (NAELA). Anthony is also the Immediate Past President of the Westchester County Bar Foundation and a Past President of the Westchester County Bar Association. He is also fluent in Italian. He can be reached at (914) 948-1500 or at [email protected]
