The current healthcare crisis has created numerous questions concerning the use of a ventilator when someone seems to be failing due to COVID 19. This highlights the common confusion between a ‘Do Not Resuscitate’ (DNR) order and a Living Will and the misconception they are the same document. While inter-related, they are very different. As explained below, neither document, in and of itself, directs or prevents health care professionals from using a ventilator to aid a patient’s breathing.
A Do Not Resuscitate (DNR) order placed in one’s medical record by a doctor informs the medical staff cardiopulmonary resuscitation (CPR) should not be attempted if the patient stops breathing or suffers a cardiac event. The order is based on the doctor’s medical opinion that resuscitation would be futile or result in harm or pain to the patient. The DNR is written by a doctor, not by the patient (although it is sometimes written at the patient’s request). Important to note, a DNR is specific about CPR. It does not state the patient shouldn’t be treated. In the case of COVID-19, ‘treatment’ includes the use of a ventilator, so it’s use is not affected by a DNR.
Living Wills generally have two components, an Advance Directive and Health Care Proxy. Advance Directives are legal documents signed by the individual, containing instructions and preferences for medical care in ‘end-of-life’ scenario. They are often relied upon if one or more doctors determine the patient is terminal, incurably and permanently unconscious, and there is no reasonable hope of recovery. A Living Will helps one avoid end-of-life suffering and relieves family members and friends of the difficult burden of making these decisions.
Living Wills can be very simple and broad-based, or they can be complex and specific. This important document does not affect the use of a ventilator during a COVID-19 crisis, where the use of the ventilator assists the patient to breathe and is the protocol for treatment. It is a much different situation, where there has been a diagnosis the patient is terminal and will not survive. In this event, mechanical ventilation is the only means of life support, as the patient will never regain the ability to breathe on his own.
A Health Care Proxy on the other hand, designates an agent to act on a patient’s behalf to make and enforce medical decisions in the event the patient is unable to give informed consent or make decisions on their own. Be Educated! Be Proactive!