DO NOT RESUSCITATE (DNR) ORDERS: What do they mean?

The following is an excerpt from Life, Life Support, and Death: Principles, Guidelines, Policies and Procedures for Making Decisions to Protect and Preserve Life, a booklet written by 10 pro-life physicians and published by American Life League.

Resuscitation-Life Support

When it is directed by a patient or the patient’s proxy that a medical treatment will not be administered, a specific order for that specific non-treatment must be written. Written orders must be as precise and clear as possible.

“Do Not Resuscitate” (DNR) and “No Code” are examples of imprecise and ambiguous orders widely–and wrongly–accepted by physicians and courts. Do these orders mean no maintenance of an airway, or no ventilation, or no cardiac resuscitation, as well as no new or additional treatment? Furthermore, in light of the weakness of human nature, once the course has been plotted by a DNR or a “No Code” order, there is a tendency to preclude, eliminate or reduce ordinary treatments, such as visits by physicians and care given by nurses and others. Therefore, broad orders of “Do Not Resuscitate,” “No Code,” and similar orders must be avoided. At no other time in medicine are treatment orders that are so broad and non-specific considered to be within the standard of care.

When it is anticipated that a patient could sustain a complication that would be immediately life threatening and not allow time for reflection and decision, specific orders to direct the Code Blue team response regarding use or non-use of a specific treatment can be written by the primary physician, provided they are also consistent with the life principles and policies discussed herein (a reference to the Life, Life Support, and Death booklet). For example:

  1. In the event of cardiac arrest, use or do not use external cardiac massage, defibrillation, etc.
  2. In the event of hypotension, use or do not use Dopamine, Levophed, volume expanders, etc.
  3. In the event of respiratory arrest, use or do not use bag and mask ventilation, endotracheal intubation, ventilator, etc.

A companion entry must be made in the medical record, including the diagnosis, prognosis, patient’s wishes, recommendations of the treatment team or consultants with documentation of their names and the date. When the patient is unable to communicate for himself/herself, attempts must be made to obtain informed consent from a proxy.

NOTE: This treasure-trove of medical wisdom and advice is available from American Life League, 540-659-4171.