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Do Not Resuscitate

Do Not Resuscitate (DNR) Form

Use our DNR Form if you don’t want cardiopulmonary resuscitation (CPR) if your heart stops, or you stop breathing.

A Do Not Resuscitate order (DNR) is used by people who do not want to be revived if their heart stops. If you have a completed and signed DNR form, medical professionals will not save your life if you go into cardiac arrest or stop breathing.

DNR forms usually must be signed by your doctor, witnesses, and a notary public. In addition, you should familiarize yourself with your state’s do not resuscitate laws before you complete your form.

Table of Contents

What is a DNR Form?

A DNR (Do Not Resuscitate) form is a legal document that expresses an individual's medical wishes regarding resuscitation efforts in the event of cardiac arrest or respiratory failure. The primary purpose of a DNR form is to specify that the person does not want cardiopulmonary resuscitation (CPR) or other life-saving measures to be performed if their heart stops beating or they stop breathing.

Key points regarding a DNR form include:

  1. Medical Context: DNR orders are typically considered in the context of serious illness, terminal conditions, or situations where attempts at resuscitation are unlikely to result in a meaningful recovery.
  1. Consent: A DNR form is completed with the informed consent of the individual or their authorized decision-maker, such as a healthcare proxy or legal guardian. It reflects the individual's personal preferences regarding end-of-life care.
  1. Scope of DNR Orders: DNR orders can be broad or specific, depending on the individual's wishes. Some DNR forms may specify a "full code" status, indicating a desire for all possible life-saving measures, while others may be more selective, permitting certain interventions while excluding CPR.
  1. Medical Staff Awareness: DNR orders are typically communicated to healthcare providers, including emergency medical personnel and hospital staff, to ensure that they are aware of the patient's preferences during a medical crisis.
  1. Documentation: DNR forms are legal documents that should be completed by applicable state or regional laws and regulations. They may require the signature of the individual, their healthcare proxy, or another authorized party.

It's important to understand that DNR orders are legally binding instructions for healthcare providers. When a valid DNR order is in place, medical professionals are obligated to respect the patient's wishes and refrain from initiating CPR or other life-saving measures.

DNR forms are an essential component of advance care planning, allowing individuals to make decisions about their medical treatment in advance and ensure that their wishes are known and honored by medical personnel and caregivers. These documents are often discussed with healthcare providers and should be part of comprehensive end-of-life planning for those facing serious medical conditions or the end stages of life.

What Does DNR Mean?

DNR stands for “do not resuscitate”. If your heart stops beating or you stop breathing, a DNR order restricts emergency medical technicians or hospital personnel from attempting to revive you.

What Does Resuscitate Mean?

To "resuscitate" means to revive or restore someone's life, consciousness, or vital functions after they have experienced a loss of vital signs, such as breathing or heartbeat. Resuscitation is typically performed in emergency medical situations, especially when a person's life is at risk due to cardiac arrest, respiratory failure, or other life-threatening conditions.

The process of resuscitation may involve various medical interventions, including cardiopulmonary resuscitation (CPR), defibrillation (the use of an automated external defibrillator or AED), artificial ventilation (providing breaths to the person), and other advanced life support measures. The goal of resuscitation is to restart the heart and restore normal breathing, allowing oxygenated blood to flow to vital organs and tissues.

It's important to note that resuscitation efforts are often initiated in response to an individual's medical crisis, but the outcome of these efforts can vary depending on the underlying condition, the timing of intervention, and the person's overall health. In some cases, resuscitation efforts are successful, leading to a full recovery, while in others, they may be unsuccessful, resulting in irreversible brain or organ damage.

The decision to perform resuscitation is a critical medical and ethical consideration, and it is typically guided by the individual's medical condition, advance directives, and Do Not Resuscitate (DNR) orders. In cases where an individual has expressed their wishes in advance, medical professionals will respect those preferences when determining whether to initiate resuscitation efforts.

When is a DNR Form Appropriate?

A Do Not Resuscitate (DNR) form is appropriate in specific medical situations and typically applies to individuals facing serious medical conditions or end-of-life circumstances. The appropriateness of a DNR form is generally determined by the individual's medical condition and their expressed wishes. Here are some situations in which a DNR form may be considered appropriate:

  1. Terminal Illness: When an individual has a terminal illness with no possibility of recovery or a prognosis of imminent death, they may choose to complete a DNR form to specify their preference to forgo resuscitation attempts.
  1. Advanced Age and Poor Prognosis: Elderly individuals with multiple chronic medical conditions and a poor prognosis may opt for a DNR order to avoid invasive and potentially futile resuscitation efforts.
  1. Irreversible Brain Damage: In cases where an individual has suffered severe, irreversible brain damage due to trauma, stroke, or anoxic brain injury (lack of oxygen to the brain), a DNR order may be appropriate, as resuscitation may not result in meaningful recovery.
  1. End-Stage Disease: Individuals with end-stage diseases, such as advanced cancer or advanced heart failure, may choose to have a DNR order in place as part of their advance care planning.
  1. Poor Quality of Life: Some individuals may complete a DNR form if they believe that resuscitation would not lead to a good quality of life, or if they wish to prioritize comfort care over aggressive medical interventions.
  1. Religious or Ethical Beliefs: Personal or religious beliefs may influence an individual's decision to have a DNR order. Some religions may have specific guidelines regarding medical treatment at the end of life.
  1. Patient's Informed Choice: In all cases, the appropriateness of a DNR order depends on the informed choice of the individual. They should have a clear understanding of the implications and potential consequences of not undergoing resuscitation.
  1. Advance Care Planning: DNR orders are often part of advance care planning, where individuals document their preferences for end-of-life care, including their desires regarding resuscitation. This allows their wishes to be known and respected by healthcare providers and loved ones.

It's essential for individuals to discuss their end-of-life preferences with their healthcare providers, as well as their family members and legal representatives when making decisions about a DNR order. These conversations can help ensure that the individual's wishes are understood and documented appropriately in their medical records.

DNR orders are legally binding instructions for healthcare providers, and they are designed to align medical care with an individual's values and preferences. In situations where a DNR order is in place, healthcare providers will honor the individual's choice and focus on providing comfort care and symptom management rather than initiating resuscitation efforts.

What Happens if a DNR is Not Followed?

If a Do Not Resuscitate (DNR) order is not followed by healthcare providers, it can lead to ethical, legal, and medical consequences. DNR orders are legally binding instructions that reflect a patient's informed choice regarding end-of-life care. Failure to honor a valid DNR order can result in various issues:

  1. Ethical Concerns: Not following a valid DNR order raises ethical concerns related to patient autonomy and informed consent. It may go against the patient's wishes and result in unwanted and potentially invasive medical interventions.
  1. Legal Liability: Healthcare providers who do not adhere to a valid DNR order may face legal liability. They can be subject to legal actions, including medical malpractice claims, for not respecting the patient's legally documented preferences.
  1. Emotional Distress: For the patient's family and loved ones, witnessing a resuscitation attempt that goes against the patient's wishes can cause significant emotional distress. It can also strain trust in healthcare providers and the medical system.
  1. Invasive Interventions: Non-compliance with a DNR order can lead to unnecessary and potentially harmful invasive medical interventions, such as cardiopulmonary resuscitation (CPR), intubation, and mechanical ventilation, which may not align with the patient's goals of care.
  1. Prolonged Suffering: Resuscitation attempts, when they go against a patient's wishes, can result in prolonged suffering and a decreased quality of life, especially if the patient has an irreversible, terminal condition.

To ensure that a DNR order is followed appropriately, healthcare providers and institutions typically have policies and procedures in place to document and communicate these orders effectively. Additionally, it is essential for individuals to communicate their end-of-life preferences clearly with their healthcare team, legal representatives, and family members to avoid any misunderstandings or disputes.

If a DNR order is in place, healthcare providers should have access to the documented order, and it should be prominently displayed in the patient's medical record. In emergency situations, it is critical for healthcare providers to quickly identify the presence of a DNR order and act accordingly.

If there is a disagreement or concern about whether a DNR order should be followed, it is advisable to seek guidance from medical ethics committees, legal authorities, or healthcare professionals with expertise in end-of-life care. The primary goal is to respect the patient's wishes, uphold their autonomy, and provide care that aligns with their values and preferences, even in challenging medical circumstances.

How to Get a DNR Form

Obtaining a Do Not Resuscitate (DNR) form typically involves several steps, and the process may vary depending on your jurisdiction and healthcare system. Here are general steps to help you get a DNR form:

Step 1: Consult with a Healthcare Provider:

  • The first step is to discuss your desire for a DNR order with your healthcare provider. This could be your primary care physician, specialist, or a healthcare professional familiar with your medical condition and treatment options. They can help you understand the implications of a DNR order and whether it is appropriate for your situation.

Step 2: Informed Decision-Making:

  • Your healthcare provider will explain the benefits and risks of a DNR order, as well as alternative treatments and options. It's essential to have a clear understanding of the potential consequences and make an informed decision based on your values and medical circumstances.

Step 3: Complete the DNR Form:

  • If you and your healthcare provider agree that a DNR order is appropriate, they will provide you with the necessary forms to complete. These forms may vary by jurisdiction but generally include your personal information and specific instructions regarding resuscitation. You may also need to sign and date the form to indicate your informed consent.

Step 4: Authorization and Signatures:

  • Depending on local regulations and your medical condition, you may need to obtain additional signatures or authorization. For example, you may need the signature of your healthcare proxy or legal guardian if you are unable to make medical decisions for yourself. Ensure that the form is properly completed and signed according to local requirements.

Step 5: Distribute Copies:

  • Make copies of the completed DNR form. Keep one copy for yourself, provide one to your healthcare provider, and give copies to any individuals involved in your healthcare decisions, such as family members or caregivers. Ensure that your DNR order is readily accessible in case of an emergency.

Step 6: Communicate Your Wishes:

  • Inform your family members, loved ones, and anyone else involved in your healthcare about your DNR order. Discuss your preferences and make sure they are aware of your wishes in case they need to advocate on your behalf.

Step 7: Medical Records:

  • Ensure that your DNR order is properly documented in your medical records. This is important to ensure that healthcare providers are aware of your preferences during emergencies.

Step 8: Update as Necessary:

  • Review and update your DNR order as your medical condition and preferences change. It's important to ensure that your DNR order accurately reflects your current wishes.

Please note that the process for obtaining a DNR form may vary by region, and specific requirements may differ. Always consult with your healthcare provider and follow local regulations and guidelines to ensure that your DNR order is legally valid and accurately reflects your preferences regarding resuscitation.

Who signs the DNR form?

The signing of a Do Not Resuscitate (DNR) form typically involves specific parties, and the requirements may vary depending on local regulations and individual circumstances. Generally, the following parties may be involved in the signing of a DNR form:

  1. Patient or Decision-Maker: The primary individual responsible for signing the DNR form is the patient themselves, if they are of sound mind and capable of making informed medical decisions. The patient's signature indicates their informed consent to forgo resuscitation.
  1. Healthcare Provider: In many cases, a healthcare provider, such as a physician, nurse practitioner, or attending physician, must also sign the DNR form to certify its appropriateness based on the patient's medical condition. This signature confirms that the decision aligns with the patient's clinical circumstances.
  1. Witnesses: Depending on local regulations and institutional policies, one or more witnesses may be required to observe the signing of the DNR form. Witnesses provide verification that the patient's signature is genuine and that the patient made the decision voluntarily. Witnesses are typically individuals who are not involved in the patient's medical care.
  1. Healthcare Proxy or Legal Guardian (If Applicable): If the patient is unable to make medical decisions due to incapacity, their healthcare proxy, legal guardian, or someone with medical power of attorney may be required to sign the DNR form on the patient's behalf. This person acts as the surrogate decision-maker and ensures that the patient's wishes are honored.
  1. Family or Next of Kin (Notification): While family members are generally not required to sign the DNR form, they should be informed of the patient's decision and should be included in the discussion regarding the DNR order. Open communication with family members is crucial to ensure that everyone is aware of and respects the patient's wishes.

It's important to note that the specific signing requirements for a DNR form can vary by jurisdiction and healthcare facility. Additionally, the process may differ if the patient is in a long-term care facility, hospice, or receiving care at home. Always consult with healthcare professionals and adhere to local regulations and institutional policies when completing a DNR form to ensure that it is legally valid and accurately reflects the patient's preferences regarding resuscitation.

FAQs

What is a DNR (Do Not Resuscitate) order?

A DNR order is a medical directive that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure.

Who can request a DNR order?

Any competent adult can request a DNR order for themselves if they understand the implications. Additionally, a legally authorized healthcare proxy or guardian can request a DNR order on behalf of an incapacitated patient.

What are the key elements of a DNR form?

A DNR form typically includes the patient's or decision-maker's name, signature, and the signatures of healthcare providers or witnesses. It may also contain information about the patient's medical condition and specific instructions regarding resuscitation preferences.

Is a DNR order permanent?

No, DNR orders are not permanent and can be revoked or modified by the patient or their decision-maker at any time. It's essential to regularly review and update the DNR order to reflect the patient's current wishes.

What happens if a DNR order is not readily available during a medical emergency?

In emergency situations, healthcare providers are trained to provide immediate care to stabilize the patient. If a DNR order is not readily available, they will initiate resuscitation efforts until the order can be verified.

DNR Form Sample

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