How to Discuss the Need for a Do Not Resuscitate Order

Discussing the need for a DNR can be emotional.

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A Do Not Resuscitate Order or DNR orders emergency medical staff to withhold CPR and other life-reviving treatments if the patient's heart or breathing stops, allowing death. We all know death is a part of every life but discussing the need for a DNR can be difficult. Here are some guidelines for when and how to discuss the need for a Do Not Resuscitate Order.

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Instructions

Difficulty: Challenging

Step1

Fully understand what a Do Not Resuscitate Order is and what it is not. A DNR is an order to emergency staff to withhold CPR and other life-reviving measures if a patient's heart or breathing stops, allowing death. It does not direct the medical care of a patient in other situations.

Step2

Discuss the need for a Do Not Resuscitate Order with your physician. Be informed of your prognosis and the risks involved in your illness. Consider these things carefully and base your decision on how you want to be treated in an emergency.

Step3

If you decide that you do not want emergency services to revive you, ensure your wishes are carried out by placing a Do Not Resuscitate Order with all the appropriate health care providers including physicians, hospitals, nursing homes and emergency services.

Step4

Choose an appropriate time to discuss the need for a Do Not Resuscitate Order with your loved ones. If you have placed a DNR, don't wait to inform your loved ones until it's too late. Decide whether you want to have a group discussion with family and friends or whether you would rather discuss it individually, one-on-one. Schedule a place and time with minimal distractions.

Step5

Start the conversation by explaining your illness, your prognosis and existing risk factors. Discuss and answer any questions your loved ones may have. Being informed can help them make sense of a difficult situation.

Step6

Announce your decision to place a Do Not Resuscitate Order with health care providers. This may stimulate objections from your loved ones. If so, refer back to the previous step of discussing your illness and risks. Be understanding and sensitive to expressed objections and emotions but be assertive about your decision.

Tips & Warnings

Having a DNR ensures family members will not have to make a decision in a crisis.
DNR Orders can be removed if you change your mind.
A DNR is one type of an Advanced Directive but does not cover all issues as to how the patient wishes to be treated if he becomes unable to make medical decisions for himself.
Keep a copy of the DNR in your home to insure that emergency medical personnel honor your wishes.

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Comments

TerriR said

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on 2/10/2008 Two very important tips. Thanks annalecta.

annalecta said

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on 2/8/2008 Sensitive & informative discussion of a difficult topic. I'd like to add two things:
1. If you wish to use a DNY, have your caregiver(s) tape a big, signed copy of it to the wall by your bed or put it in some other VERY VISIBLE spot, since many doctors & EMTs will undertake "heroic" measures if the DNY is not right in their faces.
2. If you DON'T want a DNY, don't let anyone pressure you into signing it. It's YOUR choice!!

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