Obtaining a DNR order is a life changing decision that may save you from suffering and futility. As someone who has frowned upon the idea, a bit of insight and understanding changed my mind.
What Is A DNR Order?
A DNR (do-not-resuscitate) order is provided by a doctor at your request. It is a medical order that instructs health care professionals to NOT start cardiopulmonary resuscitation (CPR) if your heart stops pumping or if you stop breathing. If you have a DNR order in place and get into an accident causing you to stop breathing, healthcare professionals will not provide CPR. On the contrary, individuals who are not DNRs are categorized as full-codes (FC) by default. That is, individuals who receive CPR in case of emergencies have a full-code status. The goal of the person providing CPR is to bring back the patient as quick as possible to prevent neurological impairment.
It sounds straightforward, but many Americans do not know the best option to select due to lack of information or because they think that the concept is irrelevant. But what do the experts choose? Given the scenario, 88% of younger doctors choose a DNR status for themselves if terminally ill. So does this mean you should too?
What Happens After CPR
About 350,000 cardiac arrests happen in the United States each year. A cardiac arrest patient would had stopped breathing and oxygen would not be able to reach his or her brain, possibly resulting in long-term damage to brain cells or even a coma.
Heart disease happens at any age and is the nation’s leading cause of death. Half a million people in the United States die of heart disease each year – and many are in their 40s and 50s. Most importantly, 90,000 people receive CPR each year and live. These individuals are full-codes and have no DNR order.
So what happens when one of the 90,000 individuals goes down and loses oxygen supply to the brain (cerebral hypoxia)? After 5 minutes without oxygen, brain cells become damaged and start to die. A series of personality, cognitive, and behavior changes take place. If the person is a full-code, CPR may help bring them back to life. If successfully resuscitated, CPR is over and the individual is now receiving the usual amount of blood and oxygen to the brain. A series of medical test are performed to determine if the individual suffered any loss of motor skills or impaired brain functions.
Any damage can happen during the loss of oxygen to the brain – including no damage at all. If severe damage happens, the person’s life changes drastically. The person might be unable to eat, swallow, talk or move, but may be completely aware of their surroundings. Sometimes the results are the complete opposite and the person keeps his or her motor skills but is unable to communicate nor function cognitively. The degree of damage from cerebral hypoxia may vary significantly.
DNR Orders Can Prevent Undesired Outcomes
How does life change after resuscitation? Individuals who have suffered brain damage and have been “brought back” with CPR may no longer be able to perform activities of daily living for themselves. They may require complete assistance with bathing, feeding, and toileting. For an unlucky percentage, neurological impairments may have been so severe that they are bed-bound for the rest of their lives. A bed-bound patient experiences a complete decline in their quality of life. Financial dependence and chronic depression usually follow.
It is also important to think about the cost associated with neurological impairment. Some patients may no longer be able to function at work and may need to rely entirely on someone else’s help.
Conclusion – Should You Have A DNR Order?
Obtaining a DNR order may prevent you from living years with severe neurological impairment. For terminally ill patients, a DNR order will prevent futile life-saving attempts with negative consequences. Individuals who cannot stomach the idea of brain damage, or individuals who may not want long-term life support, should consider becoming a DNR. Full-Code patients see resuscitation and CPR as a process that restores life. DNR patients feel that passing is a natural process and see resuscitation as potentially harmful with the ability to create suffering and futility. For DNR patients, resuscitation is too risky of a process. Should you have a DNR order? Only you can make that decision – talk to your doctor and loved ones today.