Do Not Resuscitate Orders: a confusing path to determining your death

DNRs
Letting go
Older patients
Confusion
Override
Blurry concept
Unclear limits
Keeping alive or keeping from dying?
The other side of the coin
Denying care
ICU or dialysis
Unauthorized DNRs
Elder home overreach
Possible solutions
Name-change
Specific requests
DNRs

A Do Not Resuscitate Order (DNR) is a document that informs medical personnel when a patient does not wish to receive CPR or other resuscitating care in the event of a deadly event.

Letting go

DNRs are a tool for patients to choose when to let go. It could be for religious reasons or others, like the understanding that life after resuscitation can be challenging due to the physical consequences.

Older patients

According to The New York Times, the percentage of patients with DNRs grows significantly among people older than 85 years. The consequences of CPR in older or fragile bodies can be severe.

Confusion

However, DNRs are also confusing for physicians and other health professionals. In some cases, doctors deny care to patients with DNRs, and in others, they override the orders.

Override

The NY Times said doctors commonly override DNRs. Sometimes, the medical staff is unaware of the order, and other doctors knowingly ignore the pledge due to the patient's circumstances.

Blurry concept

Dr. Max Vergo, a palliative care doctor at Dartmouth Health in New Hampshire, explained to The NY Times that resuscitation has changed.

Unclear limits

In the 1960s, Dr. Virgo said, resuscitation referred exclusively to CPR, chest compressions, and ventilation after cardiac arrest. However, now it includes other care even as the patient's heart still beats.

Keeping alive or keeping from dying?

That is why, in some cases, doctors can interpret treatments as keeping the patient alive, not resuscitating them. The NY Times cited the case of a patient who was intubated against her will.

The other side of the coin

The blurry lines around the concept can also cause doctors to deny care before cardiac arrest when they misunderstand what a patient wants. According to The NY Times, mortality rates are worse for DNR patients.

Denying care

The newspaper quoted a 2017 survey of 553 US medical residents that found that a significant portion would have mistakenly denied medical care to a DNR patient in hypothetical scenarios.

ICU or dialysis

"In one scenario, 41 percent said they would not transfer the patient to the intensive care unit, and 62 percent would not have administered dialysis," the newspaper said.

Unauthorized DNRs

Age Scotland, a charity for older adults, told the BBC that patients have accidentally discovered that their National Health Service doctor had created DNRs for them without their knowledge.

Elder home overreach

Researchers from Essex University also told the broadcaster that some elder care homes are "inappropriately" denying DNR patients access to certain medicines or transfers to hospitals.

Possible solutions

According to the NY Times, medical institutions seek solutions to clarify the confusion around DNRs and allow doctors to more easily respect patients' wishes.

Name-change

One possible solution the newspaper mentioned was changing the name of DNRs to clarify the document's purpose. It quoted "do not attempt resuscitation" or "allow natural death" as examples.

Specific requests

Other doctors have suggested "No CPR" or documents that specifically name the resuscitating procedures that patients do not want.

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