Deciding about CPR:

Do-Not-Resuscitate (DNR) Orders

A Guide for Patients and Families

Courtesy of NYS Department of Health
   WHAT DO CPR AND DNR ORDERS MEAN ?

        CPR - cardiopulmonary resuscitation - refers to the medical
        procedures used to restart a patient's heart and breathing
        when the patient suffers heart failure.  CPR may involve
        simple efforts such as mouth-to-mouth resuscitation and
        external chest compression.  Advanced CPR may involve
        electric shock, insertion of a tube to open the patient's
        airway, injection of medication into the heart and in extreme
        cases, open chest heart massage.

        A do-not-resuscitate (DNR) order tells medical professionals
        not to perform CPR.  This means that doctors, nurses and
        emergency medical personnel will not attempt emergency CPR if
        the patient's breathing or heartbeat stops.

        DNR orders may be written for patients in a hospital or
        nursing home, or for patients at home.  Hospital DNR orders
        tell the medical staff not to revive the patient if cardiac
        arrest occurs.  If the patient is in a nursing home or at
        home, a DNR order tells the staff and emergency medical
        personnel not to perform emergency resuscitation and not to
        transfer the patient to a hospital for CPR.

   WHY ARE DNR ORDERS ISSUED ?

        CPR, when successful, restores heartbeat and breathing and
        allows patients to resume their previous lifestyle.  The
        success of CPR depends on the patient's overall medical
        condition.  Age alone does not determine whether CPR will be
        successful, although illnesses and frailties that go along
        with age often make CPR less successful.

        When patients are seriously ill or terminally ill, CPR may
        not work or may only partially work, leaving the patient
        brain-damaged or in a worse medical state than before the
        heart stopped.  In these cases, some patients prefer to be
        cared for without aggressive efforts at resuscitation upon
        their death.

   CAN I REQUEST A DNR ORDER ?

        Yes.  All adult patients can request a DNR order.  If you are
        sick and unable to tell your doctor that you want a DNR order
        written, a family member or close friend can decide for you.

   IS MY RIGHT TO REQUEST OR RECEIVE OTHER TREATMENT AFFECTED BY A DNR
      ORDER ?

        No.  A DNR order is only a decision about CPR and does not
        relate to any other treatment.


   ARE DNR ORDERS ETHICALLY ACCEPTABLE ?

        It is widely recognized by health care professionals, clergy,
        lawyers and others that DNR orders are medically and
        ethically appropriate under certain circumstances.  For some
        patients, CPR offers more burdens than benefits, and may be
        against the patient's wishes.

   IS MY CONSENT REQUIRED FOR A DNR ORDER ?

        Your doctor must speak to you before entering a DNR order if
        you are able to decide, unless your doctor believes that
        discussing CPR with you would cause you severe harm.  In an
        emergency, it is assumed that all patients would consent to
        CPR.  However, if a doctor decides that CPR will not work, it
        is not provided.

   HOW CAN I MAKE MY WISHES ABOUT DNR KNOWN ?

        An adult patient may consent to a DNR order orally by
        informing a physician, or in writing, such as a living will,
        if two witnesses are present.  In addition, the Health Care
        Proxy Law allows you to appoint someone you trust to make
        decisions about CPR and other treatments if you become unable
        to decide for yourself.

        Before deciding about CPR, you should speak with your doctor
        about your overall health and the benefits and burdens CPR
        would provide for you.  A full and early discussion between
        you and your doctor will assure that your wishes will be
        known.

   IF I REQUEST A DNR ORDER, MUST MY DOCTOR HONOR MY WISHES ?

        If you don't want CPR and you request a DNR order, your
        doctor must follow your wishes or:

        - transfer your care to another doctor who will follow your
          wishes; or

        - begin a process to settle the dispute if you are in a
          hospital or nursing home.

        If the dispute is not resolved within 72 hours, your doctor
        must enter the order or transfer you to the care of another
        doctor.

   IF I AM NOT ABLE TO DECIDE ABOUT CPR FOR MYSELF, WHO WILL DECIDE ?

        First, two doctors must determine that you are unable to
        decide about CPR.  You will be told of this determination and
        have the right to object.

        If you become unable to decide about CPR, and you did not
        tell your doctor or others about your wishes in advance,
        a DNR order can be written with the consent of someone chosen
        by you, by a family member or by a close friend.  The person
        highest on the following list will decide about CPR for you:

        - the person chosen by you to make health care decisions
          under New York's Health Care Proxy Law;

        - a court appointed guardian (if there is one);

        - your closest relative (spouse, child, parent, sibling);

        - close friend.

   HOW CAN I SELECT SOMEONE TO DECIDE FOR ME ?

        The Health Care Proxy Law allows adults to select someone
        they trust to make all health care decisions for them when
        they are no longer able to do so themselves, including
        decisions about CPR.  You can name someone by filling out a
        health care proxy form, which you can get from your physician
        or other health care professionals.

   UNDER WHAT CIRCUMSTANCES CAN A FAMILY MEMBER OR CLOSE FRIEND DECIDE
     THAT A DNR ORDER SHOULD BE WRITTEN ?

        A family member or close friend can consent to a DNR order
        only when you are unable to decide for yourself and you have
        not appointed someone to decide for you.  Your family member
        Or friend can consent to a DNR order when:

        - you are terminally ill; or

        - you are permanently unconscious; or

        - CPR will not work (would be medically futile); or

        - CPR would impose an extraordinary burden on you given your
          medical condition and the expected outcome of CPR.

        Anyone deciding for you must base the decision on your
        wishes, including your religious and moral beliefs, or if
        your wishes are not known, on your best interests.

   WHAT IF MEMBERS OF MY FAMILY DISAGREE ?

        In a hospital or nursing home, your family can ask that the
        disagreement be mediated.  Your doctor can request mediation
        if he or she is aware of any disagreement among your family
        members.

   WHAT IF I LOSE THE ABILITY TO MAKE DECISIONS ABOUT CPR AND DO NOT
     HAVE ANYONE WHO CAN DECIDE FOR ME ?

        A DNR order can be written if two doctors decide that CPR
        would not work or if a court approves of the DNR order.
        It would be best if you discussed your wishes about CPR with
        your doctor in advance.

   WHO CAN CONSENT TO A DNR ORDER FOR CHILDREN ?

        A DNR order can be entered for a child with the consent of
        the child's parent or guardian.  If the child is old enough
        to understand and decide about CPR, the child's consent is
        also required for a DNR order.

   WHAT HAPPENS IF I CHANGE MY MIND AFTER A DNR ORDER HAS BEEN WRITTEN ?

        You or anyone who consents to a DNR order for you can remove
        the order by telling your doctor, nurses or others of the
        decision.

   WHAT HAPPENS TO A DNR ORDER IF I AM TRANSFERRED FROM A NURSING HOME
     TO A HOSPITAL OR VICE VERSA ?

        The DNR order will continue until a doctor examines you and
        decides whether the order should remain or be canceled.  If
        the doctor decides to cancel the DNR order, you or anyone who
        decided for you will be told and can ask that the DNR order
        be entered again.

   IF I AM AT HOME WITH A DNR ORDER, WHAT HAPPENS IF A FAMILY MEMBER OR
     FRIEND PANICS AND CALLS AN AMBULANCE TO RESUSCITATE ME ?

        If you have a DNR order and family members show it to
        emergency personnel, they will not try to resuscitate you or
        take you to a hospital emergency room for CPR.

   WHAT HAPPENS TO MY DNR ORDER IF I AM TRANSFERRED FROM A HOSPITAL OR
     NURSING HOME TO HOME CARE ?

        The order issued for you in a hospital or nursing home will
        not apply at home.  You, your health care agent or family
        member must specifically consent to a home DNR order.  If you
        leave a hospital or nursing home without a home DNR order, a
        DNR order can be issued by a doctor for you at home.


   [Hospitals must provide to patients a brochure developed by the
   State Health Department that describes the Do-Not-Resuscitate law.
   The brochure must be furnished to the patient at or prior to the
   time of admission.  It must also be furnished to each member of the
   hospital's staff involved in the provision of medical care,and it
   must be posted in a public place in each hospital.

   Patient Self-Determination Act in OBRA '90 amending 1902 (a) (58) of
   Social Security Act Public Health Law 2979]