Do Not Resuscitate (DNR) Orders
Do Not Resuscitate (DNR) order are basically notes in a patient's file that they do not want to be resuscitated should their heart stop. Some people view DNR orders as akin to euthanasia and believe that patients who request this order are ensuring their own death. However the medical establishment views DNR orders as the patient's choice, though they do request that those considering DNR orders to discuss it with their family members. DNR orders may be requested for a variety of reasons, all of them designed to keep the patient from suffering further.
DNR GuidelinesToday there are multiple guidelines in place governing when a DNR order may be issued. These guidelines include if a resuscitation attempt is unlikely to be successful, if the patient himself (while of sound mind) has stated that he does not want to be resuscitated and this preference was written down somewhere, if the patient has a living will that states that he does not want to be resuscitated or if it is believed that resuscitating the patient would lead to a worse quality of life. However these are the instances in which a DNR order can be issued, there are no guidelines regulating when a patient can request a DNR order. This means that a patient can request not to be resuscitated at any time and this wish is recorded then it should be followed when needed.
NHS Trust Policies on ResuscitationNHS Trusts also regulate their policies on the resuscitation of patients. To do so, all Trusts must have a policy on resuscitation that respects patients' rights as well as a non-executive director who is responsible for implementing the policy. This policy must be available for patients and their family members to review and it must be reviewed regularly by the Trust to ensure that it is still appropriate. Patients or family members who have never seen their Trust's policy should request a copy. Patients or family members who are concerned that a DNR order could be issued without consent should discuss this worry with hospital or Trust staff.
Discussing DNR Orders with FamilyIn theory, DNR orders are cut and dry but in practice these are emotionally charged decisions. DNR orders necessarily encompass life and death, and if families are not agreed about a DNR order for a loved one when then it can be an extremely difficult time when the order is followed. To avoid family problems, patients considering a DNR order should discuss the situation with their closest relatives. In fact, both the British Medical Association and the Royal College of Nursing have issued guidelines directing medical professionals to only issue DNR orders after the issue has been carefully considered by the patient and his or her family. While each individual will choose to hold this discussion in his own way, it is best to do so in a calm manner, by clearly stating why he wants the order, and in a private place where the family can have a truthful discussion. For their part family members should endeavour to remain calm, understand what is being said to them, and ask meaningful questions until everyone understands what is being decided.
Do Not Resuscitate (DNR) orders can be controversial, though for the most part if an individual has requested a DNR order their wishes are followed without question. Families should discuss DNR orders early so that there are no surprises should a loved one be in a position to need such an order.