¶ … Resuscitate (DNR)
What is a Do Not Resuscitate (DNR) order?
First used about fifty years ago, the do not resuscitate (DNR) order continues to elicit questions and discussion among medical experts and patients. The do not resuscitate order is a directive from a patient who specifically refuses consent for certain forms of medical interventions related to life-saving actions by hospital personnel. The presence of the DNR order makes it important that informed discussions between a specific patient, family, and physicians and staff are made regarding their medical conditions. In the modern day world, advances made in medical therapy that include end-of-life treatments, have made the presence of a DNR order even more crucial.
Epidemiological research has greatly enhanced our knowledge of the different forms and outcomes of resuscitation. However it is the physicians, patients, and institutional (hospital) policies that greatly influence the occurrence of DNR orders (Loertscher, Reed, Bannon, & Mueller, 2010).
A do not resuscitate order records the patient's directive to rule out the use of cardiopulmonary resuscitation (CPR) should circumstances arise so he/she becomes unresponsive or apneic, with or without a heartbeat. A DNR order must be in written form. The DNR order also prohibits other kinds of resuscitation interventions including: chest compressions, rescue-breathing, defibrillation, and use of sophisticated cardiovascular life support systems.
The DNR order instructs healthcare providers not to introduce a tube into the patient and start mechanical ventilation in the occurrence of acute respiratory distress or even sleep apnea. The order may only be given by patients who have severe chronic conditions that cannot improve, or those that are receiving end-of-life treatment. It prevents the caregiver from intervening to resuscitate a patient who is not breathing or does not have a heartbeat. A DNR order, however, does not prevent other forms of medical interventions. A patient can at any time cancel a DNR order (Barlow, 2014).
The difference between the DNR and a living will or power of attorney
A power of attorney is a written legal document that grants an appointed individual or board authority over certain affairs in the event the individual becomes incapacitated. The durable power of attorney (DPOA) authorizes the appointed individual to carry out bank transactions, sign social security documents, and/or sign checks to pay bills. These legal documents allow for specific appointees to act on one's behalf in particular cases. For example, one individual can be given a medical power of attorney while another can be appointed with a legal and/or financial power of attorney (Nabili, 2015).
A living will on the other hand is a written record that gives directives on what kind of medical interventions may be initiated in the event that one is incapacitated. The living will can be general or precise. The most prevalent statement in a living will is usually to the effect that if one suffers an incurable illness or disease that has been determined to be terminal by a physician, then the individual directs that all life-sustaining interventions that might help to prolong life are to be prohibited, suspended, or stopped (Nabili, 2015). Under New York State laws, a do not resuscitate order directs medical caregivers not to initiate cardiopulmonary resuscitation, i.e. emergency intervention to restart the heart or lungs in the event that such care is needed. This order instructs physicians, nurses, and/or paramedics not to give emergency treatments including intubation to open the airways, chest compressions, electric shock, injection of drugs into the heart or chest, or even the basic mouth-to-mouth resuscitation.
In New York State, any person who is 18 years and over can obtain either a Hospital or Non-hospital DNR order. A Hospital DNR order is given if one is in healthcare facility such as a hospital or hospice that is registered by the State. Paramedics are under obligation to respect a Hospital DNR Order during transit to or from the hospital. However, if one is not in any of these facilities then one should obtain a Non-Hospital DNR Order (Schneiderman).
Effects of the DNR on Medical experts and relatives
The instruction to prevent resuscitation is different in the medical profession because this is the only treatment decision that has to be made prior to the occurrence of the event. In the absence of a DNR order, the physician and all caregivers are supposed to initiate CPR in the event that the heart stops, even in cases where it is apparent that this is not the best option. Therefore all staff must be made aware if a DNR order has been issued. In the end, because the autonomy...
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