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When Is a DNR Order Appropriate?
The decision to forgo life-sustaining treatment is rarely an easy one. No one wants to die, but for many people, the time comes when treatments are no longer effective, sustaining […]
The decision to forgo life-sustaining treatment is rarely an easy one. No one wants to die, but for many people, the time comes when treatments are no longer effective, sustaining life through artificial means no longer makes sense or quality of life is poor. When this happens, it’s important to have a conversation with your doctor and your loved ones about your disease progression, your priorities and the goals of your medical care. It’s also important to acknowledge the reality that in many situations, CPR will not save your life but will simply prolong your death.
According to Brigham and Women’s Faulkner Hospital, some situations where a DNR order would be appropriate include:
- When CPR would provide no medical benefit. For example, CPR is unlikely to restore heart function or breathing in patients with widespread infections, advanced cancer, severe heart disease or other terminal illnesses.
- When CPR would damage the person’s quality of life. Especially in people who are very old and frail, CPR may be only partially successful. The person’s heartbeat may be restored, but they may have broken ribs, brain damage or be dependent on breathing support for the rest of their lives.
- Death is expected soon. People who have a terminal illness and/or are approaching the end of life may wish to avoid aggressive medical care in favor of a natural death.
In most cases, you, your family, and healthcare providers will agree when and if a DNR is appropriate. However, in rare cases, a doctor may disagree with your decision to forgo CPR. If this occurs, and there is no way to resolve the conflict through additional discussion, you may request that the doctor transfer your care to another provider. If the doctor refuses to do so, you or your family can then consult with a patient advocate, the hospital ombudsman or administrator and request that they resolve the dispute.
Sources
“MOLST: Massachusetts Medical Orders for Life-Sustaining Treatment”. Brigham and Women’s Faulkner Hospital. https://www.brighamandwomensfaulkner.org/patients-and-families/advance-care-directives/molst
