If you stop breathing and your heart stops beating, the normal emergency treatment is known as cardiopulmonary resuscitation or CPR. CPR can be as simple as mouth-to-mouth breaths or chest compressions. Advanced CPR may include electric shock, inserting a tube into your lungs to help you breathe, use of medications to help your heart beat, breathing machines to keep air flowing to your lungs, or even surgery to open your chest and massage your heart to try to get it to start beating.
Patients who are chronically ill or who have a terminal (life-ending) condition may decide they do not want to have CPR if they stop breathing or their heart stops beating. The document that communicates this decision is known as a Do Not Resuscitate order or DNR.
The phrase do not resuscitate is frightening to some people who say it sounds like “giving up.” Television shows and movies make it appear that most times when CPR is used, the patient is “cured”, gets well, and goes home. But for people who are seriously ill or have a terminal condition that will lead to their death, CPR may not be completely effective. In some cases, patients who have CPR may end up brain-damaged or in worse medical condition than they were in before.
If you have a living will, you can include the conditions for which you do not want CPR. For example, you can specify that if you are in a coma you would not want to be resuscitated. In order for your request to be valid, your doctor must sign the DNR order, which in many states is a special colored form that is included in your medical chart. Your living will can make your desire for a DNR known if you are not able to speak in person with your doctor. Under certain conditions, your Health Care Agent or family members can request the doctor to sign a DNR for you. Your instructions in your living will can guide them in making this request.
It is important to note that a DNR order that is signed for you in the hospital or in a care facility is not valid if you go home. You must have a separate DNR signed by your doctor indicating that you do not want CPR at home. If paramedics or other emergency personnel are called to your home, they may not be aware of your DNR and may be required by law to perform CPR until you reach the hospital.
Because the phrase DNR can be intimidating, some people use the phrase “allow natural death” instead of “do not resuscitate”. Both terms mean not using CPR to try to restore a normal heartbeat or breathing. But “allow natural death” can also include withholding other treatments such as medications and only providing comfort care. Your living will can clarify exactly what treatments you want if you have a terminal condition.
Sources:
NYS Dept. of Health: Deciding About CPR
Caring Connections
USA Today: ‘Do Not Resuscitate’ vs. ‘allow natural death’
Merck Manual Online