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As an estate planning law firm, we urge people to plan so that their wishes will be honored. That means more than just planning what will happen to your assets. Estate planning also means creating advance directives so that your loved ones will know what medical care you want if you are unable to express your wishes, and who should make those decisions on your behalf. A do-not-resuscitate declaration is an important component of your planning.
What is a Do-Not-Resuscitate Declaration?
A do-not-resuscitate (DNR) declaration is a document signed by an individual stating that they do not want aggressive measures such as CPR, intubation, or chest compressions to restart their heart or breathing.
A do-not-resuscitate order is then signed by the person’s physician and placed in their medical file. In the event that the patient’s heart or breathing stops, the DNR order prevents medical personnel from performing measures to resuscitate the patient. Without a DNR order in place, first responders and medical staff are obligated to attempt to save the patient’s life, even if doing so would cause pain and not add any meaningful duration or quality of life.
With a do-not-resuscitate order in place, if a patient stops breathing or suffers cardiac arrest, medical providers do not intervene to restart their heart or breathing; they are allowed to expire naturally. However, comfort care and pain relief can be provided if necessary.
Why Would Anyone Want a Do-Not-Resuscitate Order?
It can be difficult to imagine not wanting doctors to do everything possible to save a loved one. That’s why many people choose to make a do-not-resuscitate order. Family members often want to keep a patient alive “at any cost,” but often the cost is prolonged pain and suffering for the patient, without any real quality of life.
Consider this scenario. A woman, Carol, in her early 70s, has advanced cancer that has spread throughout her body. She is in constant pain, and despite having tried chemotherapy and participated in a clinical trial, her condition has become terminal. Carol has two adult daughters, Alice and Betty, with whom she is very close. Betty is coming to terms with the fact that her mother is dying, but Alice is in denial. Neither woman feels ready to let their mother go.
Carol knows that her terminal illness is hard on her family, but she is exhausted and she knows that her pain will only increase. If her heart or breathing should stop, she does not want doctors to take heroic measures to resuscitate her. She knows that CPR can be very painful and can break bones, but more importantly, she knows that her quality of life will not get any better. While she doesn’t want to die, she would prefer a peaceful, natural death.
However, Carol is worried that her daughters will want doctors to do everything possible to keep her alive. She has decided to sign a do-not-resuscitate declaration so that her doctors will put a do-not-resuscitate order in her file. That way, should her heart stop, doctors can let her go, and her daughters don’t have to agonize about whether they made the right decision—because it wasn’t in their hands.
Scenarios similar to this play out in hospitals across America every day. The patient may be elderly, with several chronic conditions, or have Alzheimer’s, or a neurodegenerative condition like ALS. In all of these situations and many more, a DNR can provide benefits not only for patients, but for their families.
The Benefits of a DNR for Patients and Families
The primary benefit of a do-not-resuscitate order is that it allows patients to exercise control over their lives and their end-of-life care. It may not be death that a patient fears so much as prolonged suffering and the loss of control over what happens to them.
While a DNR is primarily to preserve a patient’s autonomy and dignity, it has benefits for the patient’s family as well. It’s not uncommon for family members not only to disagree with the patient about resuscitation, but with each other. That can cause painful arguments about the patient’s care when the family should be supporting the patient and each other.
When a patient has a DNR and other advance directives, family members don’t have to agonize over whether they or the doctor “tried hard enough” to save their loved one. The patient has made their wishes clear through the DNR declaration, and their medical providers must carry out the DNR order. When the patient dies, the family will still grieve—but they can do so with the peace of mind that their loved one’s wishes were honored.
Dispelling Myths About DNRs
Some people are hesitant to consider a DNR because they are worried that it means their doctors will not save them in a situation in which they would want resuscitation. In reality, you can dictate when your DNR will apply—such as if you are in the terminal stage of a specific illness, or if you have irreversible brain damage.
It’s also important to emphasize that DNR stands for “Do Not Resuscitate,” not “Do Not Treat.” Doctors do not withdraw treatment from seriously ill or terminally ill patients who have a DNR; they simply do not administer CPR or other aggressive measures in the event the patient stops breathing or their heart stops beating.
You can also choose to withdraw a request for a DNR at any time as long as you are legally competent to do so. After all, the point of the document and other advance directives is to honor your wishes.
To learn more about do-not-resuscitate declarations in Michigan or to create a do-not-resuscitate declaration for your needs, contact Estate Planning & Elder Law Services to schedule a consultation.
