All About DNRs


Kathryn Chia Apothekathryn DNR

What is a DNR?

A DNR, or a Do-not-resuscitate, is a medical order written by a doctor. Its purpose is to instruct health care providers not to do CPR (Cardiopulmonary resuscitation), in the event a patient’s breathing stops or their heart stops beating. Ideally, a DNR is set up before an emergency occurs and is put it place only after talking about it with the patient and their family.


The purpose of a DNR is intended to prevent patients from suffering pointlessly from the negative effects that resuscitation can cause, such as: broken ribs, brain damage and fractures, when there is strong evidence that CPR will not restart the heart or breathing.


A DNR will not interfere with the quality of treatment a patient receives or other decisions that are made. It is specific to CPR and does not limit any other treatments such as pain medication, other prescriptions or nutrition

DNR as a passive euthanasia

Euthanasia is the practice of intentionally ending a life to relieve pain and suffering. With a DNR, a patient passes away because medical professionals refrain from doing something necessary to keep patient alive, in order to prevent additional pain and suffering. Hence, DNR is classified as a passive euthanasia.


What is CPR?

CPR, or Cardio-pulmonary resuscitation, is the treatment one receives when one’s blood flow or breathing stops. Things it may include are chest compressions, mouth-to-mouth breathing, electric shocks from a defibrillator to restart the heart, breathing tubes to open the airway and medication to increase heart rate.


How successful is CPR?

Success rates of CPR are actually a lot lower than people think. Contrary to what is often shown on medical TV dramas, where most patients survive after CPR is administered, the overall rate of survival that leads to hospital discharge for someone who experiences cardiac arrest is about 10.6%. Very often, the heart cannot be restarted because a patient is too frail or weak. CPR is not a “magic cure” for death and should instead be seen as a treatment option to circulate oxygenated blood to the brain and heart, to delay tissue death and permanent brain damage.


Disadvantages of CPR

CPR is often very aggressive and traumatic. Some have even gone on to say that if you’re not breaking ribs with compressions, you’re not doing it properly. After having gone through CPR, it can be impossible to return to one’s original state of health. This is especially true with elderly patients, or patients who have had other illnesses as well. These patients may have to be put on a respirator, suffer from brain damage and have to depend on others for care for the rest of their lives. Hence, in some cases the costs of CPR outweigh the benefits.


Why some patients want a DNR

Everyone has different beliefs, fears and values and thus reasons why people do not want DNRs vary accordingly. Below are some of the reasons why…


· Death is inevitable anyway- Some elderly patients prefer to have comfort care instead and allow natural processes to take place.

· CPR is painful and complications can set in afterwards -Because they do not have a lot of time left anyway, often because of a terminal diagnosis or old age, patients do not want to have any more additional pain just for the small amount of extra time they might be given from CPR

· Dissatisfaction with present QOL/ health status – Patients are unable to take care of themselves and they feel that there is no point in continuing to prolong life when they are unable to have a high quality of life and live independently, no matter what treatment they receive

· Lessen emotional burden on family- Individual does not want to put family through the pain of seeing them suffer and wants to die with dignity, with their family by their side

· Burden to health care workers – some patients think that it’s unfair for someone having to look after the machine that they live off and it bothers the patient that society is paying all this money just for them to stay alive when they are doing nothing


Why Some Patients do not want a DNR

· Good current QOL/ health status – Individual has no pre-existing or current health conditions and is still reasonably healthy, having a high chance of recovery

· Desire to remain with family members- For example, some parents want do not want to get DNRs as they want to spend as long as they can with their children

· Unfulfilled life goals – patients still feels there is a lot in life they still want to do and achieve and are not ready to pass away yet

· Resuscitation as standard of care- Some patients believe that in going to a hospital, resuscitation is a treatment that should be given to all, because it is the hospital’s duty to do all it can to keep their patient alive


Conclusion

A DNR can very literally make the difference between life and death. As such, it is of the utmost importance that physicians and nurses are adequately trained to make the correct ethical decisions when handling this. It is crucial for healthcare professionals to develop appropriate virtues and improve their knowledge of ethical theories and relevant clinical guidelines, to make sure that their patient’s wishes are always taken into account.



Sources

1) https://medlineplus.gov/ency/patientinstructions/000473.htm

2) https://in.reuters.com/article/us-health-cpr-expectations/cpr-survival-rates-are-lower-than-most-people-think-idINKCN1G72SW

3) https://cpraedcourse.com/a-brief-guide-the-advantages-and-disadvantages-of-cpr/#:~:text=So%20here%20are%20some%20drawbacks%20of%20CPR%20you%20need%20to%20know%3A&text=Soreness%2C%20broken%20ribs%2C%20lung%20collapse,has%20not%20passed%20before%20administration.

4) https://www.theguardian.com/commentisfree/2020/apr/08/do-not-resuscitate-orders-caused-panic-uk-truth

5)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101966/#:~:text=DNR%20patients%20expressed%20a%20desire,emotional%20burden%20on%20family%20members.

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