top of page
  • Writer's pictureSurviving Breast Cancer

The Utility of Do Not Resuscitate Orders

By Brady Scheiner



Do-not-resuscitate orders, also known as DNR orders, are typically intended to legally indicate that someone does not want to receive cardiopulmonary resuscitation (CPR) in the case of cardiac arrest. Sometimes, they are used to prevent other life-saving interventions, but this is not as common. In order to properly give a DNR order, the physician must obtain the informed consent of the patient (or their guardian). For more information on the process of informed consent, click here!


There are two general types of DNR orders: DNR Comfort Care (DNR-CC) orders and DNR Comfort Care-Arrest (DNR-CCA) orders, with DNR-CCA orders being the most common type. This order permits the use of life-saving interventions, such as chemotherapy, curative surgery, or medication, up until one’s breathing or heart stops; after this point, only interventions relating to one’s comfort are permitted (Ethics Committee). Basically, CPR will not be provided, but physicians are still expected to provide the patient with comfort care to the best of their abilities. In contrast, DNR-CC orders require that only comfort care be provided even before the patient’s breathing or heart stops (Ethics Committee). This type of order is typically used in the case of a short life expectancy or terminal illness where curative treatment does not prove to be beneficial. Another option at some hospitals is often referred to as DNR-Specified, which is a custom order crafted by a patient in consultation with their physician (Ethics Committee). This allows for a more individualized DNR order, but is unavailable at many hospitals and non-transferable between institutions. When DNR orders are discussed broadly, they are likely referring to DNR-CCA orders, as they are the least restrictive and most frequent.


Like a lot of legislation in the medical field, DNR orders are not without complication. In recent years, researchers have found that the presence of a DNR order in a patient’s charts can unintentionally decrease the use of non-CPR medical interventions (Mccaughey). Ultimately, this lower level of care can prove fatal; in fact, it was found that, following a hip surgery, patients with DNR orders had over double the mortality rate of patients without one (Mccaughey). Another frequent issue with DNR orders is that physicians may not adequately discuss the complications with DNR orders, which would constitute a lack of informed consent. Additionally, a DNR order may be overridden against a patient’s wishes; a survey of physicians showed that 69% would be very likely to disregard a DNR order and perform CPR anyways if their treatment caused a cardiac arrest (Tan). This is thought to be due to lawsuit concerns, guilt, or a lack of consideration of this possibility (Tan). On the other end of this issue, DNR orders are sometimes placed against a patient’s will, which is known as a unilateral DNR (Courtwright, et al.). Generally, this decision is made by an ethics committee or physician when they deem further treatment to be futile (Courtwright, et al.). This is especially concerning because in some cases, the patients were found to have potentially treatable conditions (Courtwright, et al.). There is lots of ongoing debate and contention surrounding this issue, even among doctors, as roughly half are opposed to this practice (Putman).


To find out the specifics of DNR orders in your state, search “DNR order laws” followed by your state! For example, a search for “DNR order laws in (insert state here)” should bring up all the information you need!


 

Citations

Courtwright, A., et al. “Unilateral Do-Not-Attempt Resuscitation Orders at

the Massachusetts General Hospital.” Medical Futility Blog, 11 May

2014,

Ethics Committee. “DNR Orders and Comfort Care.” Ethics Resources and

Services, Cleveland Clinic,

Mccaughey, Betsy. “Do Not Sign A DNR Before You Read This.” Investor's

Business Daily, 28 Mar. 2018,

Putman, Micheal S. “Ethics of Unilateral DNR Orders: Physicians Are

Evenly Divided.” Relias Media - Continuing Medical Education

Tan, S. Y. “Consent and DNR Orders.” The Hospitalist, 14 Feb. 2018,


60 views

Recent Posts

See All

Comments


Meditation Mondays:

Chakra Chanting with Gloria

Mondays at 10:00 a.m. ET 

RSVP

Thursday Night Thrivers:

All Stages Support Group

Thursdays at 7:00 p.m. ET

RSVP

 

Thursday Night Thrivers:

Metastatic Breast Cancer Support Group

First and third Thursdays

of the month at 7:00 p.m. ET

RSVP

 

Thursday Night Thrivers:

Inflammatory Breast Cancer Support Group

Second Thursday

of the month at 7:00 p.m. ET

RSVP

Tuesday Night Thrivers

Después de un Diagnóstico:

Grupo de Apoyo en Español

2do y Cuarto Martes de cada mes 

7:00 p.m. ET

RSVP​

Encourage and Empower

For Newly Diagnosed

September 10, 11:00 a.m. ET

RSVP

Breast Cancer Book Club

The first Sunday of the month

RSVP

Restorative Yoga:

Unearthing Opportunities

May 20 ,  5:30 p.m. ET

RSVP

In Body Breathwork

May 21 ,  6:00 p.m. ET

RSVP

Brain Spotting

May 27,  6:00 p.m. ET

RSVP

Qi Gong

May 28,  11:30 a.m. ET

RSVP

Art Therapy

June 3, 6:00 p.m. ET

RSVP

Forest Bathing

Jun 4,  6:00 p.m. ET

RSVP

Reflect & Recharge

Expressive Writing

June 10,  6:00 p.m. ET

RSVP

Yoga Fitness with Chair Assist

June 11, 11:30 a.m. ET

RSVP

Yoga Stretching for DIEP flap

June 11,  6:00 p.m. ET

RSVP

Más eventos en español

RSVP

Upcoming Events

1

Surviving Breast Cancer provides breast cancer support, events, and webinars at no cost to you! Whether you are looking to gain more knowledge on a particular topic or meet up with other breast cancer survivors, we have something for everyone. 

2

Our standing appointment on Thursdays is for all stages. We also host specific breakout groups once a month for specific stages and subtypes such as Metastatic breast cancer, and Inflammatory Breast Cancer, etc. 

3

The Book Club meets the first Sunday of every month at 11 am ET. You are welcome to join each month or pick and choose your month based on your availability and the book we are reading. 

4

Through art, writing, and other creative modalities, we hold the power to manage our stress, make sense of our now, and relax into moments of stillness. 

5

Free, monthly, online classes in restorative yoga, yoga for breast cancer, and Zumba. 

6

Después de un Diagnóstico

bottom of page