Understanding a Do Not Resuscitate Order


Over the years I’ve noticed that many people believe that an Advance Directive is the same as a Do Not Resuscitate Order (DNR).  An Advance Directive and a DNR are not the same, so I wanted to talk about the difference for a moment.


First, let’s review a DNR.  A DNR is a directive which basically states that Cardio Pulmonary Resuscitation (CPR) is not to be performed if a person stops breathing or their heart stops beating.  A DNR Order may be written by an individual’s doctor who has discussed the issue with them beforehand.  It may also be written by a proxy (a person who’s authorized to act on behalf of another, such as an agent), or a family member.  It has recently been incorporated into the POLST (Physicians Orders for Life Sustaining Treatment).


An Advance Directive is a written statement that addresses a person’s wishes regarding medical treatment.  It often includes a living will.  An advance directive is created to make sure that a person’s desires and wishes are carried out if s/he is unable to communicate them to a doctor.


Here in California, the “Emergency Medical Services Pre-Hospital Do Not Resuscitate (DNR) Form” (try saying that one five times fast) is an official State document developed by the California EMS Authority and the California Medical Association.  When it is filled out properly, it allows a patient with a life threatening illness or injury to decline resuscitative efforts that may keep them alive.  These measures would include: chest compressions (CPR), assistance with breathing (ventilation), inserting a tube into the trachea to help with air flow (endotracheal intubation), administering a controlled electric shock in order to allow restoration of the normal rhythm (defibrillation), and the use of drugs which stimulate the heart (cardiotonic drugs).  The DNR Order form does not keep a person from receiving other emergency medical care, including treatment for pain, difficulty breathing, major bleeding, or other medical conditions.


The POLST form is supposed to be based on effective communication of the patient’s wishes and a promise by the healthcare professional to honor those wishes.  It’s printed on a brightly colored pink form.  In 2009, California became one of 23 states to adopt the POLST form.  The POLST form is intended to complement the Advance Health Care Directive and replace the DNR.  Unlike the Advance Health Care Directive, it does not require the patient’s signature; but rather, is signed by the physician.


The Do Not Resuscitate Order form should only be executed with the advice of a physician and/or a licensed attorney (preferably an estate planning attorney) who understands the form and process.  Parrish Law in Saratoga, California is here to help.  If you or your loved one needs assistance with a DNR Order, or a Living Will, give us a call at (408)741-3500.  The first consultation is always free!

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