A Project in Bioethics: University of The Assumption

University of the Assumption
A Project in Bioethics

Submitted by:
Ramquielle Herhon D. Jingco

Submitted to:
Mrs. Cynthia R. Rivera

A do not resuscitate order, or DNR, is a medical order written by a doctor. It instructs health
care providers not to do cardiopulmonary resuscitation (CPR) if breathing stops or if the heart
stops beating.
A DNR order allows you to choose before an emergency occurs whether you want CPR. It is a
decision only about CPR. It does not affect other treatments, such as pain medicine, medicines,
or nutrition. The doctor writes the order only after talking about it with the patient (if possible),
the proxy, or family.
In medicine, a "do not resuscitate" or "DNR", sometimes called a "No Code", is a legal order
written either in the hospital or on a legal form to respect the wishes of a patient not to
undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were
to stop breathing. The term "code" is commonly used by medical professionals as jargon for
"calling in a Code Blue" to alert a hospital's resuscitation team. The DNR request is usually
made by the patient or health care power of attorney and allows the medical teams taking care
of them to respect their wishes. In the health care community "allow natural death" or "AND" is
a term that is quickly gaining favor as it focuses on what is being done, not what is being
avoided. Some criticize the term "do not resuscitate" because it sounds as if something
important is being withheld, while research shows that only about 5% of patients who
require CPR outside the hospital and only 15% of patients who require CPR while in the hospital
survive Patients who are elderly, are living in nursing homes, have multiple medical problems,
or who have advanced cancer are much less likely to survive.
[3]

A DNR does not affect any treatment other than that which would require intubation or CPR.
Patients who are DNR can continue to get chemotherapy, antibiotics, dialysis, or any other
appropriate treatments.
What Is Resuscitation?
CPR is the treatment you receive when your blood flow or breathing stops.
CPR may involve:
Simple efforts such as mouth-to-mouth breathing and pressing on the chest.
Electric shock to restart the heart,
Breathing tubes to open the airway
Medicines
Making the Decision
If you are near the end of your life or you have an illness that will not improve, you can choose
whether you want CPR to be done.
If you DO want to receive CPR, you don't have to do anything.
If you do NOT want CPR, talk with your doctor about a DNR order.
These can be hard choices for you and those who are close to you. There is no hard and fast
rule about what you may choose.
Think about the issue while you are still able to decide for yourself
Learn more about your medical condition and what to expect in the future.
Talk to your doctor about the pros and cons of CPR.
A DNR order may be a part of a hospice care plan. The focus of this care is on treating
symptoms of pain or shortness of breath to maintain comfort, but not to prolong life.
If you have a DNR order, you always have the right to change your mind and request CPR.
How to Create a DNR Order
If you decide you want a DNR order, tell your doctor what you want. Your doctor must follow
your wishes, or:
Your doctor must transfer your care to a doctor who will carry out your wishes.
Your doctor must agree to settle the dispute within 72 hours if you are a patient in a
hospital or nursing home so that your wishes are followed.

The doctor can fill out the form for the DNR order.
The doctor writes the DNR order on your medical chart if you are in the hospital.
Your doctor can tell you how to get a wallet card, bracelet, or other DNR documents to
have at home or in a non- hospital setting.
Standard forms may be available from your states Department of Health.
Make sure to:
Include your wishes in a living will or health care power of attorney.
Inform your health care proxy and family of your decision.
If you do change your mind, talk with your doctor right away. Also tell your family and caregivers
about your decision. Destroy any documents that you may have that state the DNR order.
When You Are Unable to Make the Decision
Due to illness you may not be able to state your wishes about CPR.
If your doctor has written a DNR order already at your request, your family cannot
override it.
You may have named someone to speak for you, such as a health care agent. If so, this
person or a legal guardian can agree to a DNR order for you.
If you have not named someone to speak for you, a family member or friend can agree to a
DNR order for you only when:
You are terminally ill.
You are permanently unable to decide.
CPR will not work.
CPR could cause more medical problems for you.
Reference: http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000473.htm
http://en.wikipedia.org/wiki/Do_not_resuscitate

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