David G. Bale
What is a “Do Not Resuscitate Order” or “DNR” and What does it Mean?
Estate Planning generally is accepted to refer to planning for an end game, the end of life and what happens to your property. However, it is more than that and involves more than a Will. One of the directives ordinarily discussed during estate planning with an attorney is “Do Not Resuscitate Orders”, also known as DNR Orders.
When a person chooses a DNR Order they are saying they do not wish to have cardiopulmonary resuscitation (CPR) performed. In Ohio, the Ohio Department of Health has provided for two standardized DNR orders for the end of life. A DNR Comfort Care Arrest Order will receive all medical treatment needed until the patient’s heart stops or their breathing stops. At this time, only comfort care will be provided, and not resuscitation. However, up to that time, even resuscitation is provided.
The second type of DNR order is known as a DNR-CC (Do Not Resuscitate Comfort Care Order). This allows the physicians and nurses to provide additional measures to provide comfort care before the heart or breathing stops. This is also sometimes referred to as palliative care and steps needed to add to the patient’s comfort are performed. A DNR-CC Order allows ongoing treatment for these purposes.
It is useful to note that not everyone wants CPR, though it does save lives. It is frequently not successful, or it may allow a degeneration in life quality for those who receive it by leaving them with painful side effects and/or brain damage.
Emergency squads and similar health care professionals are required to provide CPR unless the patient expressly refuses. This assumes the patient is able to refuse. A discussion with your physician can resolve your concerns about whether you do or do not want CPR, and if you choose to not have it, then the physician should select a standard Ohio DNR identification form, which is required to be honored by paramedics and other healthcare workers. The Ohio Department of Health has the form at www.odh.ohio.gov.
Also, you can designate a DNR Order through your Living Will, or in your Health Care Directive. Where you are receiving active care, the DNR Order should be part of the medical chart. If a doctor writes the DNR order, then no one can override the order. If you change your mind, the DNR order can be revoked, but you should cancel the order made on the Living Will or in discussions with your healthcare attorneys in fact under the Health Care Directives, and the best policy is to re-execute any written instructions so as to eliminate the order.
A Living Will only takes effect, however, if you are in a terminal condition or a permanently unconscious state, and since emergency personnel will not make this determination for all intents and purposes they will not affect the DNR in a Living Will. If you wish to avoid CPR, your doctor’s completion of a standard Ohio DNR identification form is the most reliable way to prepare for the unexpected if you wish not to have CPR.