DNR (do not resuscitate or no CPR) does not mean do not treat or do not care. A warning for all of us.

July 30, 2009 by  
Filed under Ask Viki


man-in-hospital-bed

Dear Viki,

I noticed that after my dad became a DNR in the hospital, the nurses didn’t come into the room as often anymore and the doctor didn’t visit the way he used to. Just because my dad didn’t want to have CPR didn’t mean that he still didn’t want to fight his cancer. But it seemed like everybody gave up on him. Did the DNR (do not resuscitate) decision really mean, Do Not Care?

I realize that not only are patients confused about what DNR means (do not do CPR), but nurses and physicians are also confused. I know that’s not what you want to hear, but it’s true. Somehow DNR has become a decision about treatment choices instead of just CPR. What DNR should mean is only one thing, do not do cardiopulmonary resuscitation.

Research has found that if a patient is a DNR, then healthcare professionals may believe that the patient doesn’t want any other types of aggressive treatment. But this isn’t true. A patient may want chemotherapy, surgery, radiation therapy or other kinds of aggressive treatments, and still not want to receive CPR. A DNR doesn’t tell you anything about what other treatments the patient might or might not want to receive.

I’m not telling you this to scare you out of being a DNR. Not at all. I am just reminding all of us that one part of the end-of-life decision making process does not dictate everything else we might want. So yes, you can be a DNR and still have appropriate aggressive medical treatments. Or you can be a DNR and choose only to have hospice care. Or you can be on hospice and not be a DNR. Or you can choose some of the medical treatments being offered and refuse others. These are all separate decisions. You get to choose from all of the appropriate medical options available. Choose some, choose all or choose none. It is up to you. The only thing you can’t choose is a treatment that is not a valid medical option. You cannot make the doctor gave you ineffective or non-beneficial treatments. You are only allowed to choose from the list of medically appropriate treatments for your condition.

Lastly, as a reminder to all the healthcare professionals. A DNR never represents a do not care order. We should still be going into their hospital room as often as we would for someone without a DNR. We should always treat the patient with respect and dignity and provide comfort care to manage their suffering.

Have a kind and respectful day.

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Comments

2 Comments on "DNR (do not resuscitate or no CPR) does not mean do not treat or do not care. A warning for all of us."

  1. MIMI on Thu, 14th Jan 2010 7:39 am 

    I AM A NURSE. Unfortunately, reading your article sadden me because your statements rain true. I have been a nurse less than 5 years, and i joined the healthcare team to actually make a difference, and to care for those who need it. And in the years, i have been working (i work at a teaching facility) it greatly infuriates me with how “DNR” status has became this thing of “DO NOT CARE”. I found myself today, ENRAGED! Trying to advocate for the life my patient. When i suggested a aggressive treatment, this doctor replied to me “No, he is a DNR.” I began arguing with him what DNR means, I mean I painted the picture! He has a pulse, he is still breathing, and he is alert… IT’S NOT BRINGING HIM BACK FROM THE DEAD!It’s in essence a treatment” But my efforts were thwarted. It pains me that the line or meaning of a DNR has became so foggy! Even the nurse who took over for me, was on the doctor’s side! What is wrong with these people? I guess my rage is more personal. My grandmother was recently hospitalized, and i was approached with the idea of making her DNR, i blantly asked the nurse, what is you meaning of DNR? (she knew i was a ICU nurse) She could not even clear cut define it. I hate to admit it, but there are more healthcare staff out there that share Ms. Viki’s article to be true than those like me, who try, unless clearly stated in a legal document. PLEASE

  2. MIMI on Thu, 14th Jan 2010 7:43 am 

    … to continue my thoughts..
    PLEASE! GET AN ADVANCE DIRECTIVE, APPOINT A DECISION MAKER, WHO WILL FOLLOW YOUR WISHES AND WILL FIGHT FOR YOU, AND MAKE IT A POINT TO SPECIFY YOU WANT A DNR AND WHAT EXACTLY YOU WILL ALLOW OR NOT ALLOW I/E WHAT EXTENSIVE LIFE SUSTAINING MEASURES YOU WILL FOREGO! I ENCOURAGE YOU TO SPEAK WITH YOU PRIMARY MD, AND EXPRESS IN AN EVENT WHAT YOU WANT TO BE DONE, AND DONT BE AFRAID TO ASK QUESTIONS, OR WHAT TO ANTIPATE IF YOU ARE IN SUCH A STATE. IN ANY EVENT, YOU SHOULD PASS AWAY WITH DIGNITY FOR YOURSELF AND YOUR LOVED ONES.

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