Recently, I discussed advance directives and the purpose they serve. There’s actually another form of advance directive that is available, typically to the very ill, terminal or elderly that also takes effect under certain circumstances. It’s called a DNR, or do not resuscitate order.
The first and biggest difference between this directive and other advance directives, particularly the living will, is that this document, while it may have been requested by the person or patient in question, is not created by that individual or by an attorney. It is created by the person’s physician, and its primary purpose is to clearly state that you do not want your heart or breathing restarted under certain conditions or circumstances. Obviously, while you are alive and able to communicate your wishes, a DNR will not enter the picture.
A DNR states that rather than take heroic, life-saving steps to sustain your life, you, in your living will and through your physician, have indicated that you be allowed to die. However, a DNR is not honored if cardiac arrest occurs during surgery or certain other procedures meant to improve the quality of life or expected to lead to your significant recovery.
Some patients, or their families, for personal or religious reasons choose to be kept alive as long as possible, no matter the cost, physical condition or resulting quality of life. Others opt to decline all life support but stipulate the care they do want, such as pain management. This is why having advance directives and surrogates to insure compliance with your wishes is so critical.
Hoping your wishes will be honored can at times be a bit tricky. Doctors took an oath to maintain life, and some hospitals may not honor decisions that do not allow everything possible be done to keep the patient alive. There can also be conflicting family emotions about life and death decisions. Understand that it is not a lack of compassion that brings a physician or hospital administrator to suggest the discontinuation of life support, but often their concern for the patient’s quality of life.
By law, doctors are obligated to honor your advance directive. If for any reason they cannot, they’re required to transfer you to another doctor who will. If your doctor refuses, you’re entitled to appeal to the ethics board, or request a court order that the wishes stated in writing by the patient be honored.
You can begin to see why clearly written advance directives are important, and why all family members and physicians should be made aware of them. It helps if you talk with your loved ones when you sign the living will directive or when you and your doctor have agreed upon a DNR order. Doing so will eliminate any questions as to what you really wanted for yourself and most likely will relieve family members of the burden of having to make these decisions themselves.
Oh, one more key point, the original DNR must remain with the patient, whether in his home, assisted living, skilled nursing home or hospital. Absence of or copies of a DNR invalidate the DNR order.
Remember, every state has its own legal requirements for advance directives, and the DNR can only be ordered by a physician. As we continue to learn more about the challenges of aging, it becomes even clearer that getting old isn’t for sissies.
Ron Kauffman is a geriatric consultant and expert on issues of aging in private practice in Henderson and Polk counties. He is the author of “Caring for a Loved One with Alzheimer’s Disease,” available on Amazon.com and at the Polk County Senior Center.  His podcasts can be heard weekly at www.seniorlifestyles.net. Contact Ron at 828-696-9799 or by email at:  drron561@gmail.com.