living your best to the end

DNR – What does it really mean?

DNR stands for Do Not Revive or Do Not Resuscitate

What DNR means:

If your heart stops, or you stop breathing,

You do NOT want to be brought back to life via CPR or by having a tube stuck down your throat (intubate) attached to a ventilator (breathing machine)

“[having a]DNR was associated with better quality of life in the week before death. If patients have DNR orders completed, they are likely to have a better quality of life/quality of death than if they do not complete a medical order like this.” medical research journal

A DNR decision might be different for an otherwise healthy 40-60 year old, than for an 80-90 year old with multiple health issues.

What a DNR does NOT mean: Do Not Treat

Just because you may not want ‘heroic measures’ of CPR or breathing machines, there’s much that can be done for care and comfort. DNR does NOT mean ‘do not care for this patient’:

“When health care professionals speak to patients and family members about DNRs, all too often the family believes we will abandon care and stop all treatment. Often all they hear is the “not” in “do not resuscitate.” Regardless of how much time and energy we spend explaining DNR orders to the family, This negativism confuses many people, who think that approving a DNR order gives permission to terminate their loved one’s life. Or, they may be reluctant to agree to the order because they feel guilty that they are not helping their loved one as they feel they should.

Asking for a DNR does not mean that we have stopped care. What it means is that we have simply changed the goal of treatment. But to patients and family members who are emotionally–not clinically–involved in the situation, this truth may not be apparent.” Hospice Patients Org

Wait! I DO want to be revived! I want “Full Code”

If you do indeed want CPR – knowing both the risk of broken ribs and bruising, and survival after being in Intensive Care, you do want to be revived if your heart stops and you do want to be revived through CPR – your wish is described as a Full Code.

“When a patient with a full code and his or her heartbeat is on the verge of stopping or has completely stopped, the health care team will often provide emergency measures in attempt to resuscitate the patient. This may involve chest compressions, electric shocks, and emergency medications that act to temporarily keep blood moving to essential organs such as the brain.” Dr Brian Secemsky Breaking It Down: The Patient Code Status

Having CPR does not guarantee ‘back to good health’

“Oftentimes, even if patients do survive [resuscitation], they are treated in the ICU, they are intubated, they may not survive to discharge, they may have lots of complications from the procedure that may be undesirable,” Dr. Jacqueline Yuen, MD. acphospitalist.org

The wish – and decision – to be revived or not to be revived is completely different than the wish – the desire – to be kept comfortable.

Substitute Proxy Surrogate Agent

These words all mean the same thing:The person you’ve assigned to make decisions on your behalf, if you become too ill or injured to do so.

This is a very tricky, trying and emotional decision for anyone to make, and it’s more than likely that someone else WILL have to make that decision if you’ve not made your wishes clear

Substitute decision-making is the norm rather than the exception.

“50% of life-prolonging decisions are made by the substitute decisions maker, and often at the most emotionally trying time – in the Intensive Care Unit (ICU)acphospitalist

Consider carefully who that ‘someone’ [substitute, surrogate, proxy or agent] will be: if you haven’t spoken to them about what you would like, and made sure they’re as comfortable as possible in carrying out your wishes, research shows that PTSD – Post Traumatic Stress Disorder – is a common amongst those assigned to make those difficult decisions..

When completing your Advance Directives such as BestEndings, consider sharing with everyone who matters, including your health care professionals, and putting a copy in a plastic bag in your fridge, with a Vial of Life sticker on the fridge door alerting any Emergency Response paramedic that your paperwork’s in the fridge.

Remember: As long as you are able to make your own decisions you can change your mind at any time

 

Interesting reads: Comfort Care

Palliative and Hospice Care