DNR word from stone blocks in a doctor's hands

Understanding Do Not Resuscitate (DNR) Orders

The Elder & Disability Law Firm, APC July 20, 2023

While you might not find it pleasant to think about, end-of-life care is an important subject to consider while making an advanced care plan. Enlisting the help of an attorney can expedite the process and start you on the path to peace of mind. For help with advance care planning in California, call Esther C. Wang at The Elder & Disability Law Firm, APC, serving Redlands as well as other locations in Southern California, including Riverside, Rancho Cucamonga, and Palm Springs. 

If you are drafting an advance care plan, you might be thinking about creating a Do Not Resuscitate (DNR) order. Before you begin, you may find it useful to familiarize yourself with important terms and requirements relating to the implementation of a DNR order.  

What Is a Do Not Resuscitate (DNR) Order?

A Do Not Resuscitate (DNR) order is a document stating that, in the event that you stop breathing and/or your heart stops beating, you do not want the intervention of emergency lifesaving procedures such as cardiopulmonary resuscitation (CPR). 

You can also refuse artificial ventilation, endotracheal intubation, and cardioversion (heart-stimulating drugs or electric shocks to the heart). A DNR is often most helpful to ensure peace of mind for patients who are elderly or face a terminal diagnosis and would like to have some control over how they end their lives.

Another type of DNR is the Allow Natural Death (AND) order, most useful for hospice patients. An AND order can state that only comfort measures, rather than lifesaving measures, should be taken. This can allow your medical provider to administer painkilling drugs while discontinuing measures such as resuscitation, feeding, and fluids. 

Common Misconceptions

Contrary to some beliefs, a DNR order does not mean that you have given consent to be denied all medical care. For example, if you have a DNR order, you can still receive artificial nutrition, fluids, and treatment to manage pain as well as any other medical condition. A DNR order simply means that you will not be resuscitated should you enter respiratory and/or cardiopulmonary arrest. 

You might have also heard that DNR orders are difficult to revoke. This is not true; you can change your mind about the DNR order at any time, verbally or in writing. Even if you are in an emergency situation, you can tell EMTs or any healthcare provider that they should disregard the existing DNR order. 

Legal Requirements and Documentation Process

The requirements for creating a DNR vary from state to state. In California, a DNR order must include the patient’s name and the date of the order, and must be signed by you (or your healthcare agent) and your physician. The DNR will be entered into your medical records. However, to make sure that the DNR order can be easily found in an emergency, you can request a medical bracelet to wear on your person at all times. You can also make sure that you and your family members always carry a copy of the form and that a copy is available in a prominent place in your home.  

A DNR is a type of advance healthcare directive—or a document that states your wishes for your healthcare should you become incapacitated. A DNR order can only be revoked by you, a medical professional, or a healthcare agent, so it is important to name a trusted person as your healthcare agent. In California, the Advance Health Care Directive Form allows you to draft a living will (in which you can further specify your decisions for your end-of-life care) and choose your healthcare agent.  

Factors to Consider When Choosing to Establish a DNR Order

Since CPR can cause injury (such as broken ribs and heart damage) leading to intense pain, some patients who are near the end of their lives elect to create a DNR order. It is important to take your medical history and conditions into consideration when creating a DNR order.  

There are also some ethical issues to think about. You may want to speak to your family and address any concerns they might have to avoid emotional pain later. In addition, some healthcare providers may not give the same level of treatment or care to patients who have DNR orders. It’s important to discuss the DNR order thoroughly with your healthcare provider to figure out whether a DNR is right for you.  

Get the Information You Need

An attorney can help you to draft your healthcare plans and make sure that those plans are legally valid. For over thirty years, elder law attorney Esther C. Wang has been guiding her clients through the process of advance healthcare planning. Call Esther C. Wang at The Elder & Disability Law Firm, APC in Redlands today for a consultation.