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What does a "do not resuscitate" order mean?
A
"do not resuscitate" (DNR) order indicates that a person -- usually
with a terminal illness or other serious medical condition -- has decided not to
have cardiopulmonary resuscitation (CPR) performed in the event his or her heart
or breathing stops. A DNR order is written by a physician after discussing the
pros and cons of CPR with the patient or the patient's surrogate decision maker.
If CPR saves lives, why would anyone want a DNR order?
There
are various methods of CPR that often involve more than chest compressions and
mouth-to-mouth resuscitation. CPR also may include the use of powerful drugs or
electric shock to start the heart beating again, or may require the insertion of
a breathing tube.
Although CPR can save lives, it frequently does not work. Even if a person is
resuscitated, he or she may suffer painful injuries during CPR or may be left in
a worse condition than before. Also, people with terminal illnesses or other
serious medical conditions may not want to have CPR performed on them, even if
that means they may die as a result.
You and your physician should discuss the pros and cons of CPR and the
options that are best for you in your medical condition.
How do I make my wishes known about CPR?
You
do not need to make special arrangements if you want to receive CPR during a
medical emergency. However, if you do not wish to receive CPR during a medical
emergency, you must discuss your wishes with a physician who can inform you
about the details of writing a DNR order.
You have the right to refuse CPR, but you may not be able to state your
wishes during a medical emergency.
What does Ohio law say about DNR orders?
Ohio
law recognizes a standard category of DNR orders called DNR Comfort Care, which
protects a person's right to choose not to receive CPR.
State-approved DNR Comfort Care orders are designed to prevent health care
professionals and emergency workers from performing CPR, whether you are inside
or outside a health care facility. Health care providers will, however, be
required to provide you with comfort care, even if CPR is withheld. Comfort care
is any action taken to promote patient comfort, such as administering pain
medication or offering emotional support.
State-approved DNR Comfort Care orders cannot be cancelled by a family member
without your consent, and are considered "portable" because they
remain in effect as you travel to and from a hospital or other health care
facility.
What are my options for DNR orders?
There
are three different kinds of DNR orders available at the Cleveland Clinic. The
first two options are based on the state-approved DNR Comfort Care orders:
1) DNR Comfort Care
DNR Comfort Care orders (DNRCC) require that only comfort care be
administered before, during or after the time a person's heart or breathing
stops. This type of order is generally regarded as proper for a patient with a
terminal illness, short life expectancy or with little chance of surviving CPR.
2) DNR Comfort Care-Arrest
DNR Comfort Care-Arrest orders (DNRCC-Arrest) permit the use of life-saving
measures (such as powerful heart or blood pressure medications) before a
person's heart or breathing stops. However, only comfort care may be provided
after a person's heart or breathing stops.
3) DNR Specified
Valid only at the Cleveland Clinic hospital, DNR Specified orders are
uniquely tailored by your physician. They may permit the use of some CPR
treatment methods (such as powerful medications) while possibly prohibiting
other methods (such as electric shock).
All three options are available to you if you are hospitalized in the
Cleveland Clinic hospital. The first two types of DNR orders can be changed to
outpatient DNR orders when you leave the hospital, but you will need a different
bracelet or other identifier. If you are an outpatient, the first two types of
DNR orders can be written for you, but not the third type.
If you are considering having a DNR order written, you should discuss these
options with your physician to determine which DNR order might be best for you,
given your medical condition.
How will health care professionals know what DNR order I have?
While
in the hospital, you will be required to wear a plastic yellow wrist bracelet
that will identify which of the three DNR orders you have chosen with your
physician.
If you are able to leave the hospital and you want a DNRCC or a DNRCC-Arrest
order to remain as part of your treatment plan, your physician can provide you
with a state-approved DNR form, a DNR bracelet or a DNR wallet card.
If you receive care at home, you should tell your family and caregivers where
to find your DNR order form and identification.
What happens if I have a DNR order and I need surgery?
In
the event that you need surgery, you and your physician will re-evaluate your
DNR order prior to the procedure. Together, you and your physician will decide
what treatment methods should be used during surgery and immediately afterward.
A special pamphlet explaining your options will be available to you.
What happens to my DNR order once I leave the hospital?
State-approved
DNR orders (DNRCC and DNRCC-Arrest) remain in effect if you are discharged from
the hospital, and should be honored by emergency squads and other health care
professionals throughout Ohio. Before leaving the hospital, you should talk to
your physician about providing you with state-approved means of DNR
identification, such as a DNR form, a DNR bracelet or a DNR wallet card.
DNR Specified orders apply only within the Cleveland Clinic. If you have a
DNR Specified order and are leaving the hospital, the order ends when you are
discharged from the hospital. You and your physician should discuss the option
of changing the order to a DNR Comfort Care or DNR Comfort Care-Arrest order.
What if I change my mind after a DNR order is written?
You
always have the right to change your mind and request that CPR be administered
during a medical emergency. If you do change your mind, you should destroy all
DNR forms and identification that you were given or you are wearing. You also
should inform your physician and your nurse immediately so that your DNR order
may be revoked. You also should inform your family and other caregivers of the
change in decision.
What if I'm healthy now but do not want CPR if I become terminally ill?
You
can state in a Living Will that you do not want CPR. However, a Living Will does
not apply in Ohio until you become terminally ill or permanently unconscious and
can no longer make your own health care decisions. In Ohio, your Living Will
takes effect once two physicians determine that your condition meets either of
these criteria. Your physician will then write one of the DNR Comfort Care
orders according to your specified wishes.
For more information:
To request
ethics assistance or a formal ethics consultation, contact:
Department of Bioethics at: (216) 444-8720 or 1-800-223-2273 ext. 48720 8:00
a.m. to 5:00 p.m. Monday through Friday
After regular business hours, call (216) 444-2200 and ask that Bioethics be
paged at pager # 22512
Hearing impaired assistance (TTY), call (216) 444-0261
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