DNR: A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. National Library of Medicine
Question: As much as I wish he would reconsider, my dad insists on having a DNR in place. How do I make sure any medical professionals who might treat him know about this—especially if things happen quickly and I’m not nearby to convey his wishes?
Answer: I’m going to offer both some fact-based guidance as well as some perspective, but before I do that let me offer a word of respect to you for navigating these uncomfortable topics, honoring your father’s wishes, and laying out the communication pathways now rather than wait until circumstance forces them up with sudden intensity and complexity.
What is a DNR and what do you do with it?
One simple confirmation is that a DNR (Do Not Resuscitate) is in fact a medical order. To make communications clear and formal, some states require a form called a MOLST or POLST (Medical/Physician’s Orders for Life Sustaining Treatment) to be completed by a doctor, which can then be distributed to any collaborating care providers (nurses, care managers, home health aides, specialists, etc.).
Whether you’re your father’s main care provider or “just helping out,” it will fall to you to confirm which form your state requires and then make sure all relevant parties are informed of his wishes. Keep copies for future circumstantial use, such as a hospitalization. The form will often provide instructions on the parties to whom you should distribute this documentation of your father’s wishes so they can align their actions accordingly.
The form will often provide instructions on the parties to whom you should distribute this documentation of your father’s wishes so they can align their actions accordingly.
A rule of thumb is to post a copy on the refrigerator in the home where he resides. This is a place emergency workers know to check. As is so often the case with any form of coordination: Go ahead and over-communicate.
A rule of thumb is to post a copy on the refrigerator in the home where he resides. This is a place emergency workers know to check.
Move forward together, in alignment
You’re doing well in seeking to produce alignment among your father, his medical care providers and yourself, which is a significant leadership challenge. It’s hard work logistically and emotionally, so again I give you credit for taking it on.
Alignment means we’re moving together directionally, whereas agreement means we share the same opinions on details. Our preference, of course, would be for our loved ones to live well for as long as possible, but how people set their own definitions of that “living well” component can create some tension. Individuals’ wishes for their own lives rule the process, and everything else must align with that. As a result, some people prefer the unofficial phrase of “Allow Natural Death” (AND), instead of “Do Not Resuscitate” (DNR).
Individuals’ wishes for their own lives rule the process, and everything else must align with that.
Another topic to address is the range of common perceptions of the effectiveness of cardiopulmonary resuscitation (CPR) and its implications for the “living well” element mentioned above. Most of us think of CPR as a simple life-saving intervention, but what is less understood is that quality of life and survival after the administration of CPR are greatly reduced the older one becomes.
There are significant costs to one’s physical health that accompany the intensity of CPR (which requires tremendous recovery) in addition to the illness that made CPR necessary to begin with.