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What Are the Two Types of DNR Orders?
A do not resuscitate order is a doctor’s order that instructs healthcare personnel not to institute CPR if a patient’s heart or breathing stops. As a rule, it is considered […]
A do not resuscitate order is a doctor’s order that instructs healthcare personnel not to institute CPR if a patient’s heart or breathing stops. As a rule, it is considered appropriate only for patients who would not benefit or may actually be harmed by resuscitation, such as those who are terminally ill or very elderly and medically frail.
Until recently, only one type of DNR order existed. However, some U.S. states have now instituted two levels of DNR: DNR Comfort Care and DNR Comfort Care-Arrest. Both have the goal of allowing a patient to refuse extraordinary life-saving measures but differ in important ways.
- DNR Comfort Care is what may be viewed as a traditional DNR. It is appropriate for patients for whom CPR would likely not extend life and could result in significant harm. When a DNR Comfort Care order is in place, healthcare personnel, including EMS first responders, are required to provide any measures that could enhance the patient’s comfort, such as pain medicine or oxygen, but not to perform CPR or employ other extraordinary means to keep the person alive.
- DNR Comfort Care-Arrest is an order that allows healthcare providers to institute life-saving measures until the point that a person’s heart or breathing stops. For example, a person experiencing a life-threatening infection might receive antibiotics, oxygen, and powerful medications to support their blood pressure. But if that person stopped breathing, they would not receive CPR.
Additionally, some hospitals (for example, Ohio’s Cleveland Clinic) allow a physician to specify what resuscitative measures a patient should receive in the event of a cardiac arrest. For example, the DNR order might specify that providers can insert a breathing tube and institute CPR, but they are not to give electric shocks to restart the heart. If a patient wishes to be provided life-saving treatment but not have a breathing tube, this order is sometimes referred to as Do Not Intubate or DNI.
Sources
“Do-Not-Resuscitate (DNR)”. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/8866-do-not-resuscitate-orders
