Implementing Do Not Resuscitate Directions at Home

January 15, 2021 Paul Emile Trudelle General Interest Tags: , , , 0 Comments

When sick, elderly or injured patients are hospitalized, the hospital usually has a discussion with the patient or their substitute decision-maker about end-of-life decisions. In particular, there usually is a difficult discussion about the extent to which the patient is to be resuscitated in the event of heart stoppage. Often, the patient wants to be allowed a natural death, with no heroic measures to prolong life, such as intubation or other artificial life supports. Such decisions can be made for a number of reasons, such as the person’s religious beliefs, a desire to avoid the pain and possibly harmful effects of resuscitation efforts, or a concern about quality-of-life post-resuscitation.

(It has been argued that calling the decision a “DNR” is stigmatizing, and should be called an “Allow Natural Death” order instead.)

If a decision to forego resuscitation is made, a “Do Not Resuscitate” (“DNR”) order is completed[1]. The decision is noted on the patient’s file, and often on the whiteboard by the hospital bed.

Difficulties can arise, however, when the person is not hospitalized at the time. If the person is at home and suffers an incident, the attending paramedics may have no way of knowing about any DNR decision. Ontario does not have any form of registry for DNR decisions, so paramedics have no way of searching on-line for DNR decisions.

In an interview with CBC Judy Nairn, Executive Director of Hospice Waterloo Region, suggested that people at home with concerns about their DNR order being honoured should put it on their fridge door: paramedics always look their first[2].

The news report referred to a 67-year-old woman who was so concerned that her DNR wishes be respected that she wears her DNR request around her neck.

It is not enough just to make the decision about resuscitation efforts. It is important to take steps to ensure that the decision, once made, is respected and acted upon.

Thank you for reading.

Paul Trudelle

[1] For a copy of the form, click here. Jennifer Hartman blogged on the development of the DNR Confirmation Form here.

[2] For this reason, the frail and elderly should also always keep contact information and details of any medical conditions and medications on their fridge.

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