A lot of people are confused about Do Not Resuscitate (DNR) orders. Many people confuse a Directive to Physicians (Living Will) with a DNR order. While it is true that a Directive to Physicians may indicate that a person does not to be resuscitated, it is only a directive, or instructions. A DNR order is a medical order, and must be signed by a physician. If you think you have a DNR order, but your document does not have a physician's signature, you do NOT have a DNR.
To further confuse things, there are two types of DNR orders. Today we will talk about DNR orders that you may have in a hospital setting, and some of the recent changes in Texas law regarding these orders.
When a person chooses DNR as an option, it means that if the person's heart stops, or they stop breathing, they do not want any of several interventions done. These interventions include chest compressions, electric shocks to the heart, medications, and/or a breathing tube inserted into the mouth and into the airway, so the person can be hooked up to a breathing machine or ventilator.
These are very invasive procedures, and are often unsuccessful for people who are older, or who have multiple medical problems. According to an article published by the Journal of Internal Medicine, only about 14% of patients survive to discharge, which doesn't mean they are functioning as they did before they were resuscitated. If a person has significant medical problems, survival rates drop even lower.
A DNR order in a hospital is always situation specific. That means if you are admitted to the hospital in January and a DNR order is written, and you go home that month, that DNR order expires. If you go back to the hospital in April, a new DNR order would have to be written.
In Texas, new laws just went into effect in April 2018 about how DNR orders are to be implemented. In general, the order must be written by an attending physician, the order has to be dated and placed in the medical record. It appears that the new law only allows the patient or the Medical Power of Attorney to decide on DNR status.There are also provisions to make sure there is some prior documentation that the person wants to be DNR. At this point, some of the rules are still unclear, so if you think you or a loved one may want DNR orders, the safest thing may be to make sure you have current advance directives that specifically address DNR status. As we learn more about these changes in Texas law, we will try to keep you updated.
And remember, CQEC cannot give legal advice, so if you have specific questions about this, talk to an attorney who is knowledgable about advance directives, or talk to your doctor about DNR status now, while you are not in a medical crisis.
Next month we'll talk about out of hospital DNR orders.