What is DNR?
Do not Resuscitate is a directive made by the patient, giving instructions to the extent of treatment that should be attempted, in case their heart or lungs should fail. This decision is best made in advance, in the absence of a crisis. It usually involves a dialogue between the patient, the family and the physician. This is mainly done to save the patient pain and suffering and to save the family the difficult decision of withdrawal of life support in futile situations. It is not a decision to withhold medical treatment for any reversible condition. No “death panels” are involved, contrary to irresponsible fear mongering that has previously gone on, instead of a meaningful dialogue about end of life care.
In the absence of such a discussion, when the heart or lungs fail, CPR is instituted. The heart undergoes electric shocks to jump start it, in between ongoing chest thumping to maintain circulation to the brain. Oxygenation is maintained by introducing a tube into the air passage, via the nose or mouth; a ventilator machine conducts respirations mechanically. The patient is often sedated, so as to not fight the indwelling ventilator tube and pull it out. All of this has the ultimate aim of helping the body recover the ability to do for itself, after the cause has been treated. The goal is to wean the patient off the machines.
But what if the cause is worsening cancer, or a failing heart, or failing lungs from irreversible emphysema? If the primary cause is not going away, the patient may never be able to be weaned from the machines. The family is then left with the difficult decision to disconnect the machines. Sometimes, this process can take weeks, which means weeks of needless suffering for everyone.
Instead, when the medical condition warrants, it may be worth having a discussion as to what the patient wants. If they want CPR, then it will be performed. But if they do not want to go that route, treatment is not carried beyond the point of futility.
Here is a beautiful poem that illustrates the emotions of this dialogue. it was published in the JAMA in October 2012.
http://jama.jamanetwork.com/article.aspx?articleid=1386613