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Luke Perry, TV star, recently died of a stroke. His death raised the issue of health care directives and the use of a Do Not Resuscitate order.

Do Not Resuscitate (DNR) orders originated as directives, almost routinely entered into patients’ medical records preventing the use of resuscitative measures in the event of cardiopulmonary arrest.  Fifty years ago, physicians, on their own, frequently entered their own decisions into patients’ charts, presuming the physician best understood the patient’s values and medical outcomes. Families naturally need medical information in making such difficult choices.  Of course, if a patient were capable of making a meaningful decision, physicians could establish such rules to conform to each patient’s particular desire.  As long as a patient reasonably understands the possible risks and benefits of future medical interventions, they could approve a DNR on their own. 

In considering treatment options with regard to establishing a DNR, it is important to acknowledge the basic order only considers cardio pulmonary resuscitation and does not relate to any other kind of treatment, such as surgery, medication, or chemotherapy.   However, it would be wise to both determine and document any specific preferences with regard to treatment, to eliminate possible “boiler-plate” interpretations of a DNR policy. 

Some considerations:  1). In the event of cardiopulmonary arrest at home or in an extended care facility, would resuscitation be allowable for the purpose of transporting the patient to the hospital?  2).   What is the distinction between futile treatments and those with sufficient therapeutic benefits?

The line between what can be considered a medical treatment or an ethical requirement can be blurred.  Be explicit in your preference.  Before writing a DNR, the family may want to reach a consensus, in consultation with the patient’s physician, regarding the following choices:

  1. Should CPR be instituted within a hospital setting?
  2. Should emergency medical technicians or nurses refrain from employing CPR in the event of a crisis?
  3. What other steps, such as pain management, should be employed and when?
  4. Should hospitalization itself be rejected (because it can be disorientating and for most diseases of the elderly is not likely to change outcomes), except to treat a clearly reversible condition?

Act now…and apply your own specifics, with clear and knowledgeable judgment!  Be Educated! Be Proactive!

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