Question
13: When should Do-Not-Resuscitate orders
be
written for you?
A Do-Not-Resuscitate order is a doctor's instruction
written
into your medical chart (often a loose-leaf notebook)
which
tells the nurses that if you begin to die,
no
attempt will be made to interrupt the process of dying.
Most hospitals and nursing homes have written policies
of
always attempting to resuscitate patients when dying begins.
Medical
institutions have automatic procedures in place,
which
will be called immediately into action to provide
cardio-pulmonary
resuscitation (CPR)
—which
attempts to make your heart and lungs work again—
and
other measures to restore vital functions.
The only way to avoid this automatic response
is
to have an order written by your doctor in your chart stating that you
do
not want to be resuscitated if and when you begin to die.
This
is usually called the DNR order—for Do-Not-Resuscitate.
Until the 1980s patients and families were not asked about DNR orders.
It
was a private (and sometimes secret) decision by the doctor.
He
knew when further attempts to save the patient would be futile;
and
he ordered the nurses not to call the resuscitation team
—the
"crash cart"—if the patient's heart or lungs stopped functioning.
It was not uncommon in the past for a doctor to decide
(without
consulting the patient or the family)
to
create a secret Do-Not-Resuscitate order for the patient.
This
was done by purple dots pasted on the patient's chart,
special
marks on the door of the patient's room,
a
code word or number—in pencil—on the patient's card
in
the cardex at the desk (thus not a part of the patient's chart),
or
a list on a blackboard at the nurses' station.
All
of these secret signs were intended to communicate with the staff
while
at the same time keeping the decision secret
from
the patient and/or the family members.
These
secret DNR signals were kept outside the official medical record
so
they could easily be erased, removed, discarded, etc.
—and
the fact of the decision not to resuscitate could easily be denied.
Such paternalism by the doctor was supposedly for the patient's
good.
But
some studies have shown that the doctor's views
of
who should be resuscitated were more often wrong than right
when
compared to the views of the patients and their families.
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YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE
But since the 1980s, new laws require informed consent
from
either the patient or the proxies for a DNR order.
The
doctor is still the primary professional consultant for DNR orders,
but
the basic decision must be made by you and/or your proxies.
If
you do not want to make a DNR decision yourself,
you
can assign this responsibility to your proxies,
but
you should provide some guidelines in your 'living will'.
The
selection above is the beginning of Question 13 from the book:
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
If you click
this title, you will see
the complete table of contents.
The table of contents shows the several other sections of this Question.
If you
would like to see one person's Answer to this Question,
go to James
Park's Advance Directive for Medical Care.
Scroll down to Answer 13.
Go to
the beginning of this website
James
Leonard Park—Free
Library