A do not resuscitate document is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Abbreviated DNR, such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy.
DNR documents are widespread in some countries and unavailable in others. In countries where a DNR is unavailable the decision to end resuscitation is made solely by physicians.
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Alternative names
Alternative namings and abbreviations for this order are used depending on the geographic region. DNR (Do Not Resuscitate) is a common abbreviation in the United States and the United Kingdom. It may be clarified in some regions with the addition of DNI (Do Not Intubate), although in some hospitals DNR alone will imply no intubation. Some areas of the United States and the United Kingdom include the letter A, as in DNAR, to clarify "Do Not Attempt Resuscitation." This alteration is so that it is not presumed by the patient/family that an attempt at resuscitation will be successful. Since the term DNR implies the omission of action, and therefore "giving up", some have advocated for these orders to be retermed Allow Natural Death[1]. New Zealand and Australia (and some hospitals in the UK) use the term NFR or Not For Resuscitation. Typically, these abbreviations are written without periods between the letters, i.e. AND/DNR not A.N.D./D.N.R..
Until recently in the UK it was common to write "Not for 222" or conversationally, "Not for twos." This was implicitly a hospital DNR order, where 222 (or similar) is the hospital telephone number for the emergency resuscitation or crash team.
Usage by country
Middle East
DNRs are not recognized by Jordan or the Palestinian territories. Physicians attempt to resuscitate all patients regardless of individual or familial wishes.[2]
Netherlands
New Zealand
United States
The DNR decision by patients was first litigated in 1976 in Karen Ann Quinlan v New Jersey. The New Jersey Supreme Court upheld the right of Quinlan's parents to order her removal from artificial ventilation. In 1991 Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an individual's decision in their healthcare.[3] Forty-eight states currently permit the next of kin to make medical decisions of incapacitated relatives, the exceptions being New York and Missouri.[4] Legislation that would grant relatives such power in New York, The Family Health Care Decisions Act of 2009, passed that state's senate in August, 2009, and is awaiting a vote in the state assembly.[5]
In the U.S., cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS) will not be performed if a valid written "DNR" order is present. Many US states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures.[6][7]
See also
- Cardiac arrest
- Power of attorney
- Euthanasia
- Uniform Rights of the Terminally Ill Act
- Patient Self-Determination Act
References
- ^ Alternative to "DNR" Designation: "Allow Natural Death" - Making Sense in the Health Care Industry
- ^ "Mideast med-school camp: divided by conflict, united by profession". The Globe and Mail. August 2009. http://www.theglobeandmail.com/life/health/mideast-med-school-camp-divided-by-conflict-united-by-profession/article1257723/. Retrieved 2009-08-22. "In hospitals in Jordan and Palestine, neither families nor social workers are allowed in the operating room to observe resuscitation, says Mohamad Yousef, a sixth-year medical student from Jordan. There are also no DNRs. “If it was within the law, I would always work to save a patient, even if they didn't want me to,” he says."
- ^ "The continuing ethical dilemma of the do-not-resuscitate order". AORN Journal. April 1998. http://findarticles.com/p/articles/mi_m0FSL/is_n4_v67/ai_20972811/. Retrieved 2009-08-23. "The right to refuse or terminate medical treatment began evolving in 1976 with the case of Karen Ann Quinlan v New Jersey (70NJ10, 355 A2d, 647 [NJ 1976]). This spawned subsequent cases leading to the use of the DNR order.(4) In 1991, the Patient Self-Determination Act mandated hospitals ensure that a patient's right to make personal health care decisions is upheld. According to the act, a patient has the right to refuse treatment, as well as the right to refuse resuscitative measures.(5) This right usually is accomplished by the use of the DNR order."
- ^ Finally give N.Y. families end-of-life decisionmaking power, New York Daily News, Sept. 6, 2009
- ^ Finally give N.Y. families end-of-life decisionmaking power, New York Daily News, Sept. 6, 2009
- ^ "Frequently Asked Questions re: DNR's". New York State Department of Health. 12/30/99. http://www.health.state.ny.us/nysdoh/ems/policy/99-10.htm. Retrieved 2009-08-23. "May EMS providers accept living wills or health care proxies? A living will or health care proxy is NOT valid in the prehospital setting."
- ^ "DO NOT RESUSCITATE – ADVANCE DIRECTIVES FOR EMS Frequently Asked Questions and Answers". State of California Emergency Medical Services Authority. 2007. http://www.emsa.ca.gov/personnel/DNR_faq.asp. Retrieved 2009-08-23. "# What if the EMT cannot find the DNR form or evidence of a MedicAlert medallion? Will they withhold resuscitative measures if my family asks them to? No. EMS personnel are taught to proceed with CPR when needed, unless they are absolutely certain that a qualified DNR advance directive exists for that patient. If, after spending a reasonable (short) amount of time looking for the form or medallion, they do not see it, they will proceed with lifesaving measures."
External links
- Right To die Debate on Opposing Views
- Example of a DNR form
- Do Do-Not-Resuscitate orders endanger patients? Pro and Con arguments
- Decisions Relating to Cardiopulmonary Resuscitation Published by the Resuscitation Council (UK)
- DNRhu | Online Donor Magazine(HU)
- Example of a DNR dogtag
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