Don't do CPR on me at the last minute - Let's talk about the DNR (Do-Not-Resuscitate) order

Imagine that a loved one, perhaps your mother, father, or grandmother, is terminally ill. If their heart suddenly stops beating or they stop breathing, doctors will do their best to save them. But those treatments may only cause more pain. This is where the concept of DNR comes into play. Although this is a sensitive topic, it is important for all of us to be aware of it.

Simply put, what is a DNR order?

DNR is an abbreviation for the English words "Do-Not-Resuscitate" . In Sinhala, it means "do not resuscitate" . This is a medical order. To be precise, it is an order given to medical staff not to try to revive someone if their heartbeat or breathing stops.

Under normal circumstances, if someone's heart stops beating, doctors will do everything they can to save their life. This may include:

• CPR (Cardiopulmonary Resuscitation): You've probably seen it in movies where they give artificial respiration by pressing on the chest. That's what CPR is.
• Intubation and Ventilator: When breathing is difficult, a tube is inserted through the mouth or nose and connected to a machine (mechanical ventilation) to provide breathing.
• Defibrillator: An attempt to restart a stopped heart by delivering an electric shock to the heart.

But imagine that someone is already very sick, perhaps in the final stages of an incurable disease like cancer. For such a person, such treatment may only increase their suffering. That is where a DNR order comes in handy. It gives the patient the opportunity to make decisions about the end of their life.

If lives can be saved, why would someone request a DNR order?

This question may have come to you too. If CPR can save lives, why would anyone say no to it? There are several reasons for this.

A person with a terminal illness may want to live the last days of their life with dignity and without pain. CPR is not as simple as it may seem. It can break the ribs and damage the lungs. For someone who is very sick, even if they are able to live after something like this, their life can be even more miserable.

Also, CPR is not always 100% successful. The probability of success is much lower, especially in the elderly or those with multiple medical conditions. It is essential for the doctor to talk openly about this with the patient and family.

Are there different types of DNR orders?

Yes, there are slight variations in these orders as well. It can vary depending on the hospital, the country, and the patient's preferences. Let's look at some of the main types.

You can resolve any questions you have about these by talking to your doctor or a family member's doctor.

How do I express my consent?

This is a very important step.

1. Talk to your doctor: Talk openly with your primary care physician or your family doctor. He or she will explain the pros, cons, and risks of CPR to you.

2. Informed Consent: This is not just a story. After the doctor explains everything to you, you should make this decision with full understanding. That is called `(Informed Consent)`.

3. Take time to think: This is not a decision to be made in a hurry. If you need time to think about this and talk to your family, tell your doctor.

4. Documentation: Once you have made a decision, the doctor will record the order in your medical record. You can also get a copy of it. Some countries even have special ID bracelets for this purpose.

Usually, when admitted to a hospital, doctors ask the patient or family about this.

What happens if I am in a situation where I cannot make a decision for myself?

Imagine that someone has lost consciousness after an accident, or is not in a state to make a decision for some other reason.

• If you already have a DNR order: If you have already made a DNR order and it is in your medical records, not even your family can change it. It is in effect as a way of respecting your wishes.
• If there is no DNR order: If you have a Power of Attorney, that person can make decisions for you. In Sri Lanka, it is usually a close family member (e.g. spouse, children) who makes decisions in these situations.

What if I change my mind after a DNR order is placed?

You have the right to change your mind at any time. If you change your mind, let your doctor know immediately so he or she can record the change in your medical record.

Also, inform your family and caregivers of this. If you have copies of the DNR order, destroy them.

What happens to a DNR order when undergoing surgery?

This is something that a lot of people ask. If you have a DNR order and are about to have surgery, be sure to talk to your surgeon and anesthesiologist about it.

Sometimes, normal procedures that occur during surgery and anesthesia (such as controlling breathing) can conflict with a DNR order. Therefore, doctors may ask you to temporarily suspend the DNR order for the duration of the surgery. Ask them about any questions you may have about this.

It's important to discuss these things with your doctor and loved ones before they become necessary. That way, everyone knows your wishes. That way, you can receive care that meets your needs and priorities until the end.