We all love life, right? But one day, perhaps when we are very ill, nearing the end of our lives, there will come a time when we have to think about what kind of medical care we want and what we don't want. Although this is a sensitive and difficult topic to talk about, it is very important to be aware of our rights and wishes. That is what we are going to talk about today, and that is `(DNR)`.
What does `(DNR)` mean? Let's simply understand?
Simply put, `(DNR)` is an abbreviation for the English words "Do-Not-Resuscitate" . In Sinhala, this means that we have informed you in advance that "do not resuscitate." This is a kind of advance directive . You have made a `(DNR)` order, which means that if your heart stops beating or your breathing stops, you do not want to be treated with `(CPR)` (cardiopulmonary resuscitation).
Usually, doctors, nurses, and other health care workers do everything they can to save your life. This includes performing ``CPR'', which is chest compressions and mouth-to-mouth breathing to help your heart and lungs work again. And:
- If breathing is difficult, a breathing tube (`Intubation`) is inserted and connected to an artificial breathing machine (`Ventilator` / `Mechanical Ventilation`).
- If the heart's function becomes irregular, an attempt is made to restore the heart to normal by administering an electric shock (a `shock`) from a special machine (using a `defibrillator`).
But what if you are already very sick, or have a terminal illness? That's where `(DNR)` orders come in. A `(DNR)` can be useful if you want things like:
- Minimize the pain and suffering you feel at the end of your life.
- Preserve your dignity at the moment of your death.
A ``DNR'' order is usually written by a doctor, after careful discussion with you and/or your legal decision-makers, if you wish, and your family. Depending on the law in your state, a ``DNR'' order is only valid if it is written by a physician (MD or DO) or a designated health care professional.
It's best to prepare a ``DNR'' order before an emergency occurs. This order tells health care workers not to perform ``CPR'' if your heart or breathing stops. The doctor who writes this order will add it to your medical record (``Medical Chart'') so that others can see it.
Are there different types of `(DNR)`?
Most of the time, when we say `(DNR)`, we mean `(CPR)` and related treatments such as the use of a `(Defibrillator)`. However, there are other similar orders that are more specific. Sometimes, these types of `(DNR)` can also vary depending on the law in your country/region. Let's look at some examples.
- Do not attempt resuscitation (DNAR): This is the same as DNR. In some places, some health care facilities use this name.
- Allow Natural Death (AND): This means giving only the treatment necessary to make you as comfortable as possible. The main goal here is to prevent you from suffering when you die.
- Do not intubate (DNI): This tells the doctor that you do not want to be intubated or connected to a ventilator if you are unable to breathe on your own.
- Specific DNR orders: These are orders that can be tailored to the individual. For example, you may say no to CPR, but you may not want to have other life-saving treatments, such as a defibrillator.
- Comfort care orders: These can tell you what kind of care you can receive at the end of your life. They can also express your wishes to help you be as comfortable as possible at the end of your life.
There may be different types of ``DNR'' depending on where you live and your situation. Your doctor can tell you more about your options.
If CPR saves lives, why would anyone place a DNR order?
This is a question that many people face. Some people with terminal illnesses or serious health conditions do not want to receive CPR, even if it could result in their death. Deciding to make a DNR order can give you a sense of control over your life and give you some strength.
Although CPR can save lives, it is not 100% effective. Also, CPR may be less effective in people who are very sick or have certain medical conditions. It is also common to suffer painful injuries such as broken ribs and sternum fractures during CPR.
Imagine, someone is very old and suffering from incurable cancer. If their heart stops beating, and even if CPR is given to revive them for a while, it will only cause them more pain and no relief, they may choose to have a DNR. That is their decision.
How do I communicate my wishes (DNR)?
Talk to your primary care provider or the team leader who is treating you about this. Your doctor will discuss the pros and cons of CPR and related treatments with you. This is an honest conversation with you about what you really want. It is very important to give informed consent during these discussions. This will help you know everything you can and make a decision based on your personal preferences. If you want to think about it further or talk to your family, it is okay to tell your doctor . It is common to hear about a DNR order when you visit the doctor's office or when you are admitted to the hospital.
After you get a `(DNR)`, your doctor can record it in your ``Medical Record``. He or she can give you a copy to keep with you. You can even find ``Medical ID Bracelets`` that you wear so that emergency responders know that you have a ``DNR``.
What happens if I can't make a decision about `(DNR)` myself?
If you are unconscious due to illness or an accident, or if you are otherwise unable to make informed decisions, you may not be able to express your wishes about a ``DNR''. If you already have a ``DNR'' order, which is in your medical record, your family cannot change it.
If you don't already have a `(DNR)`, you can name someone to speak for you. For example, your legal representative (`Power of Attorney`) or someone who has given you authority to make other medical decisions (`Healthcare Proxy`) . If you don't name someone, sometimes a family member can make medical decisions for you if you are unable to make decisions. The family members who can make decisions for you can vary from country to country and from region to region.
What if I change my mind after a DNR order is written and given to me?
You always have the right to change your mind about your ``(DNR)``. If you change your mind, tell your doctor right away. He or she can then record the change in your medical record. You should also stop using things like identification cards that you wear on your wrist, and destroy any copies you have.
Tell your family and other caregivers that you have changed your mind and that you no longer want your `(DNR)`.
What happens if you revive someone who is on `(DNR)`?
``(DNR)`` orders only affect medical professionals who know about them (or should reasonably be aware of them). If a doctor doesn't know about your ``(DNR)``, or if there's a communication error, they won't necessarily get into trouble.
However, if your doctor knows about your `(DNR)` and still revives you, they may face legal consequences. If they were negligent and did not know about your `(DNR)`, they may also face consequences for that.
Nonmedical professionals are not legally obligated to perform CPR on someone who has a DNR. If you are trained to perform CPR on someone who is having a heart attack, you should try to do so. However, if you know that someone has a DNR, you should respect their wishes not to resuscitate them.
If I am having surgery, will a ``DNR'' affect my care?
If you have a `(DNR)` and you are going to have surgery, be sure to talk to your surgeon and anesthesiologist about your `(DNR)`. They can tell you more about how your `(DNR)` will affect any part of your surgery.
In some cases, your anesthesiologist, surgeon, or both may ask you to temporarily suspend your ``DNR'' during surgery. This is because some of the common aspects of surgery, especially general anesthesia, can conflict with your ``DNR''. If you have any questions about this, don't hesitate to ask your surgeon or anesthesiologist. It is essential to explain your concerns to them to ensure that you receive care that meets your needs and wishes.
The most important thing to remember (Take-Home Message)
Even when you are nearing the end of your life, you have the right to make decisions about your care. A ``Do Not Resuscitate'' (DNR) order empowers you and gives you the opportunity to choose the types of treatment you receive.
It's best to talk to your doctor about your end-of-life care well in advance of when you might need it. Planning ahead helps your healthcare team and your loved ones know what you want. That way, you can get care that meets your needs and priorities right up until the end of your life. Don't be afraid to talk about this, it's your right.
` DNR, do not resuscitate, advance directives, CPR, life-sustaining treatment, final will, medical decisions, terminal illness, comfort care
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න