Two Kinds of Do Not Resuscitate Orders
If you’ve been admitted to a hospital, doctors may ask if you have an “advance directive” or “medical directive” document. This can include a living will, which indicates the life-saving measures you want taken or don’t want in the event you are permanently incapacitated, including a Do Not Resuscitate (DNR) order.
What Is a DNR?
A DNR order is a legal document that directs your doctor not to administer life-saving measures if your breathing stops or your heart stops beating. A DNR document allows for your wishes to be followed when you can’t make decisions yourself or for an appointed person, such as a spouse, guardian, a family member, or friend to make those decisions for you.
What many people don’t know is that there are two kinds of DNR orders—one for hospitals and one for non-hospital locations.
A hospital DNR form will be signed by a doctor at the hospital and will become part of your medical file. This form will indicate whether or not you want life-saving measures to be taken if your heart stops beating and/or you stop breathing. If you have a lengthy hospital stay, confirm with your representative periodically that they should continue to follow your DNR preferences and not resuscitate you.
A hospital DNR should be reviewed at least every seven days during a lengthy hospital stay, in case of changes in the decision to resuscitate.
In the state of New York, a non-hospital or “out of hospital” DNR can also be signed for decisions about resuscitation outside of a hospital setting. This should be part of your end-of-life estate planning, so your family knows your wishes if you should become incapacitated. A non-hospital DNR is to be followed in situations outside of a hospital—for example, by paramedics and EMS workers or caregivers in your home, a nursing home, or an assisted living residence.
If you have a non-hospital DNR but do not have one with a particular hospital, doctors should follow the non-hospital DNR unless:
- The DNR is not valid
- The patient is awake and alert and requests the DNR not be followed
- A family member who has decision-making power for the patient strongly objects to the DNR and could cause a confrontation
Non-hospital DNRs require a particular form issued by the state health department that also has to be signed by a physician. This form should be reviewed and/or renewed every 90 days to ensure that the person continues to want no resuscitation.
To ensure your wishes are followed with a non-hospital DNR, it’s a good idea to carry a card or wear a bracelet that indicates that you have a DNR. You can also provide copies of your living will that express your wishes to your loved ones, doctors, physicians, and local hospitals to keep on file in case you become a patient.
Why Would Your DNR Wishes Change?
When you entrust someone to authorize a DNR, you’re giving them the power to decide whether to use life-saving measures if you stop breathing. This is a big responsibility. In a best-case scenario, you will discuss your wishes with someone in advance so they understand your wishes.
But following someone’s wishes can be a gray area. For example, you might have told a doctor you want to be resuscitated, so they did not sign a DNR. But if you have a lengthy hospital stay and your health continues to decline, you could be suffering. Prolonging someone’s life can be cruel, especially if there is little hope they can recover. If you’re a representative and your spouse or relative is suffering, you might then elect to sign a DNR so that if they experience cardiac arrest, they will not be resuscitated and can pass away naturally.
Our New York Elder Law Attorney Can Help With DNRs
If a DNR isn’t worded correctly or signed with the proper number of witnesses, the doctor treating you could override your wishes, especially if your designated health care agent disagrees with your DNR preferences. A New York estate planning attorney can help you prepare important legal documents such as a will, living will, power of attorney, and DNR form so your wishes will be followed even if you aren’t able to express them.