Thinking about end-of-life care isn’t easy, but making medical decisions now can ensure your wishes are honored in the future.
One important decision to discuss with your health care provider is a medical order referred to as “code status.” Your code status tells your care team how to respond if you experience a life-threatening emergency, such as when your heart stops beating or you stop breathing.
Some people choose a do-not-resuscitate (DNR) order for their code status. This order tells the medical team not to intervene with CPR (cardiopulmonary resuscitation) if you have died. A DNR order only applies to CPR. It does not mean your medical care will change in any other way.
A DNR order can be placed in your electronic medical record in the hospital or can be a written directive for out-of-hospital care.
A DNR order is an important medical decision. To learn more, we spoke with Michelle Brassil, MD, a palliative care doctor with Banner Health.
Why would someone choose a DNR order?
Deciding on a DNR order is a personal choice. Several factors may influence this decision, including:
- Your current health: Do you have a terminal illness or a serious medical condition?
- Your quality of life: What does a good life look like for you? What are you hoping life will look like after CPR?
- Medical burden: How much are you willing to go through for the possibility of more time?
- Your desire to have your wishes respected: Dr. Brassil recommends asking yourself, “How much do I want to be in control of the end of my life, or how much do I want to leave in the hands of my surrogate decision-makers?”
“Giving your loved ones a road map to follow in specific situations can be a real gift,” she said.
What is the difference between a DNR order and other advance care planning documents?
A DNR order is just one piece of the umbrella term referred to as advance care planning. Other important steps to advance care planning include completing the following advance directives:
- Medical durable power of attorney (MDPOA): This document allows you to express who you would want making medical decisions on your behalf if you were ever unable to speak for yourself. This is different from a Durable Power of Attorney because the MDPOA only comes into play for medical decisions.
- Living will: This advance directive is a legal document that is typically completed with the assistance of a lawyer. It outlines your wishes about medical care, including what treatments you do or do not want, in case you are unable to make decisions for yourself in the future.
- POLST (physician orders for life-sustaining treatment) form: “This document includes orders to the medical team on whether to intervene (perform CPR) if you your heart stops or you stop breathing. It also addresses how much medical treatment you may want, or not want, if you have a serious illness,” Dr. Brassil said. “The form is intended to be completed by a physician, nurse practitioner or physician assistant and must be signed by one of these providers as well.”
POLST forms are often printed on bright-colored paper and they follow you wherever you go: home, rehab facility, nursing facility, etc. The form should be kept in an easy-to-find place, like on the front of your refrigerator, for emergency medical services personnel to see.
Each state may have a different name for a POLST form. For example, in Colorado, it is called a MOST (medical orders for scope of treatment) form.
A common misconception about DNR orders
Many people worry that a DNR order means their medical team will stop caring for them. That is not true. A DNR order only applies to CPR. Patients with a DNR order can still receive treatments like antibiotics, oxygen and pain management.
“A DNR order does not impact any other aspect of your medical care. It absolutely does not mean do not treat, nor does it hasten your death,” Dr. Brassil said.
How can I update my code status to DNR?
If you agree to a DNR order, follow these steps:
- Talk to your health care provider: They will update your code status in your electronic medical record and help you complete an out-of-hospital DNR directive and/or POLST form.
- Tell your family: Make sure your loved ones, especially your designated MDPOA, understand your wishes.
- Keep a copy at home: Place your DNR order or POLST form in a visible location, like the front of your refrigerator, so emergency medical personnel can find it easily.
Can I change my mind?
Yes! You can reverse a DNR order at any time. If you decide you want CPR, let your health care provider know. They will update your Code Status to “Full Code” and remove the DNR order from your medical chart.
Takeaway
Deciding on a DNR order is a personal choice.
“It is important to think about your medical condition and how you define quality of life,” Dr. Brassil said. “Talk to your loved ones and discuss your options with your health care provider so your wishes for end-of-life care are honored.”
Having these conversations now can ensure that your choices are respected when it matters most. If you have questions about a DNR, reach out to a Banner Health provider for more information and to discuss your preferences.
