Do-Not-Resuscitate (DNR) Forms

What is a Do-Not-Resuscitate order?

A Do-Not-Resuscitate (DNR) order is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating or if they stop breathing. This order is usually made for individuals who have a severe or terminal illness and do not wish to undergo life-saving measures in certain situations. The decision to have a DNR order is personal and may be influenced by factors such as the individual's medical condition, quality of life, and personal beliefs.

An individual typically consults with their healthcare provider to establish a DNR order. The decision is often documented in a specific form known as a DNR form. This form outlines the individual's wishes regarding resuscitation and is signed by the healthcare provider, the individual, their physician assistant, and sometimes their family members or legal representatives.

It's important to note that the requirements for DNR orders may vary by jurisdiction, and the terminology or legal forms used for medical orders can differ. Additionally, individuals may express their wishes regarding resuscitation natural death in other legal documents, such as living wills or advance directives.

Family members and legal representatives should have healthcare professionals and medical staff be aware of the individual's preferences and the existence of a DNR order to ensure that healthcare providers and hospital staff are informed and can respect the individual's wishes in emergencies. Individuals should discuss their end-of-life care preferences with their healthcare providers and legal representatives to ensure their wishes are accurately documented and communicated.

When to use this form?

A Do-Not-Resuscitate (DNR) form is typically used in situations where an individual has made a conscious decision not to resuscitate or to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Here are some critical instances when to use this form:

• Terminal illness or poor prognosis: DNR orders are often considered for individuals diagnosed with a terminal illness or those with a poor prognosis where the likelihood of meaningful recovery is minimal.
• Personal wishes: DNR orders are based on the individual's wishes and preferences. If someone does not wish to undergo CPR or other life-sustaining measures, they may choose to express this through a DNR form.
• Quality of life considerations: Individuals may use this form when prioritizing maintaining their quality of life over the potential risks, burdens, or lack of effectiveness associated with CPR and other aggressive resuscitative measures.
• Informed decision-making: Individuals should thoroughly discuss with their healthcare providers before deciding on a DNR order. This allows for informed decision-making, considering the specific circumstances of the individual's health and understanding the potential outcomes of resuscitative measures.
• Advance directives and living wills: DNR preferences are often documented in advance directives or living wills, legally binding documents that outline an individual's healthcare preferences, especially in end-of-life situations.
• Healthcare professionals' recommendations: Healthcare professionals, including physicians and physician assistants, may guide the appropriateness of a DNR order based on the patient's medical condition, prognosis, and treatment goals.
• Emergency medical services (EMS): Individuals with a DNR order should ensure it is known to emergency medical services (EMS) personnel. EMS providers are trained to respect and follow such orders when responding to emergencies.
• Healthcare agents: Suppose an individual has appointed a healthcare agent through a durable power of attorney for healthcare or a similar legal document. In that case, the agent may decide to use a DNR order.

It's important to note that the decision to use a DNR form is highly personal and should be made after careful consideration, discussions with healthcare providers, and, if necessary, involving family members or designated healthcare agents. Regular reviews of these preferences may be required to ensure they align with the individual's current values and health status.

How to write a Do Not Resuscitate Form

A Do Not Resuscitate form is a legal document that outlines an individual's wish not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures in the event of cardiac or respiratory arrest.

It is important to note that the process of creating these forms may vary depending on your jurisdiction, and it's crucial to consult with a healthcare professional or legal expert to ensure compliance with local laws and regulations. Here are the general steps you should follow:

• Identify the document: Title the document as "Do Not Resuscitate Order" or "DNR Directive."
• Personal information: Include the full legal name of the person for whom the DNR order is being created. Include the date of birth, address, and other relevant identification information.
• Healthcare proxy or legal representative: If applicable, include the name and contact information of the person designated as the healthcare proxy or legal representative.
• Physician information: Include the attending physician's name, signature, and contact information issuing the DNR order.
• Statement of DNR request: Clearly state the individual's desire not to receive resuscitation in the event of cardiac or respiratory arrest. Specify that this directive includes but may not be limited to CPR, artificial ventilation, cardiac compression, advanced airway management, and artificial nutrition.
• Duration of DNR order: Indicate whether the DNR order is permanent or if there are specific conditions or time frames under which it is applicable.
• Witness signatures: Have the document witnessed by at least two individuals who are not involved in the individual's healthcare and are not beneficiaries of the individual's estate.
• Notary public (optional): Depending on local regulations, you may choose to have the DNR form notarized to add a layer of legality and authenticity.
• Copies and distribution: Make copies of the signed and witnessed DNR form. Distribute copies to relevant healthcare providers and the individual's primary care physician, and keep a copy in a readily accessible location.
• Review and renewal: Periodically review the DNR order and, if necessary, renew it by local regulations.
• Document retrieval: Ensure the DNR form is easily accessible to emergency medical personnel, caregivers, and healthcare providers.

Living Will vs. DNR order

A Living Will, Medical Power of Attorney, and Health Care Power of Attorney are legal documents that address different aspects of healthcare decision-making, particularly when individuals cannot communicate or make decisions about medical care or healthcare providers. Here's an overview of each:

Living will

A Living Will is a legal document that outlines an individual's medical care and treatment preferences in case they can't communicate or make decisions. It typically covers end-of-life decisions, such as the types of medical treatments or life-sustaining medical interventions the person wishes to receive or avoid in specific situations.

A medical power of attorney

A Medical Power of Attorney designates someone to make all medical health care professionals' decisions on behalf of another person if they cannot do so themselves. The agent should act by the person's wishes or in their best interest. This document allows for flexibility in decision-making.

Health care power of attorney

A Health Care Power of Attorney is a legal authority that allows an appointed agent or health care professionals to make medical treatment decisions on behalf of another person based on their values and preferences as a health care agent.

Do-Not-Resuscitate (DNR) order

A DNR do not resuscitate order instructs healthcare providers not to resuscitate order or to give a do not resuscitate order to either renew or perform CPR if the person's heart stops or if they stop breathing. It's usually implemented in cases of natural death where resuscitation may be futile or not in line with the individual's wishes.

Can a DNR be revoked?

Yes, a do-not-resuscitate (DNR) order can be revoked by the individual who signed it as long as medical records show they are mentally competent. To cancel or alter the order, it is essential to communicate the changes to all relevant parties, including healthcare providers and legal representatives.

Sometimes, a DNR order can also be revoked by a family member or a legally recognized healthcare agent if the physician misses a patient or changes their mind about the DNR. However, the decision to write a DNR order rests with the physician and the patient, and family disagreements or opinions do not reverse a DNR order when the physician, the patient, or themselves have not changed their mind.