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An Example of a DNR, and Why It Can Help

Posted August 30, 2012 by Franciska Kiraly, M.D.

In the last blog post, we started to discuss important topics relating to medical decision making, including DOPA's, living wills and DNR's. And although these topics are difficult to think about, it is important to be aware of them and to talk about them with your family or caregivers.

It's important to know that when you are cared for in a hospital, you get the default setting of "Full Code" as a patient. This means that all measures will be taken to keep your heart beating and keep you breathing.

As an example, imagine a woman in her 90s is in the hospital for a urinary tract infection. The nurse happens to check on her and finds her unresponsive in bed, not breathing and her heart not beating — which means she has died. She does not have a DNR (Do Not Resuscitate) on record, and so the hospital staff may begin resuscitation.

This would involve chest compressions, which in rare occurrences can result in complications for the frail elderly, and defibrillation, or small electrical shocks to the heart. The patient may also need a breathing tube inserted and ventilator to breathe for him or her.

If the care team does get the patient's heart beat back, once someone has had resuscitation in the hospital, statistically, their chance of long-term survival is very slim. When you add on other medical problems including advanced age and debility, a full recovery is often not possible.

It's important to know what could happen during you or your loved ones stay if a severe hospitalization were to occur. It's important to talk with your loved ones about what they'd really want in these situations, and if there is a hospitalization, to let the physicians and staff know what those wishes are. It's also not uncommon to remind the hospital staff about your wishes at future hospital visits.

A good acronym to know is MOLST or POLST (Medical or Physician Orders for Life Sustaining Treatments). These are words that you may not be familiar with, but they are in the pipeline; and hopefully we'll soon be using them regularly. Although these are similar to a DNR, a MOLST or POLST lays out a more specific list of wishes.

Because I knew this information, when my frail and elderly great uncle went to the hospital, I requested to speak to another physician and implement the DNR process. I talked with another physician and said that my relative wouldn't want to have CPR or be placed on a ventilator. They documented our discussion and made the information available to the staff so if something were to happen at night, the staff wouldn't react in default mode. Instead, they would honor his wishes.

Although my great uncle didn't have any issues during his hospitalization, I felt better knowing that the care team would be following his wishes if he did die in the hospital. So, take the time, talk with your family members, and designate a DPOA (Durable Power of Attorney for Healthcare). If you have any other questions about your own situation, please discuss them with your doctor.

Franciska Kiraly, M.D.
Hospice and Palliative Medicine Fellow
Summa Health System


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