Legal Definitions - do-not-resuscitate order

A Do-Not-Resuscitate (DNR) order is a legal instruction given by an individual, or their authorized representative, to medical professionals. This order directs that if the person's heart stops beating or they stop breathing, no attempts should be made to revive them through cardiopulmonary resuscitation (CPR) or other life-sustaining measures. DNR orders are typically put in place when a person is in a hospital, nursing home, or similar healthcare facility.

• Example 1: Mrs. Eleanor Vance, 88 years old and living in a skilled nursing facility, has advanced heart disease and dementia. She previously discussed her end-of-life wishes with her family and physician, stating she does not want aggressive medical interventions. Her family, acting as her legal representatives, ensures a DNR order is placed in her medical chart. If Mrs. Vance's heart were to stop while at the facility, the medical staff would honor the DNR order and not initiate CPR.

  Explanation: This illustrates a DNR order for an elderly patient with chronic conditions in a long-term care setting, where the order prevents resuscitation efforts as per her wishes.

• Example 2: Mr. David Chen, a 65-year-old patient admitted to the hospital for complications from terminal cancer, has a DNR order in his medical records. He made this decision after consulting with his doctors and family, expressing his desire for a peaceful end without invasive procedures. Should Mr. Chen experience cardiac arrest during his hospital stay, the medical team would respect his DNR order and provide comfort care instead of attempting resuscitation.

  Explanation: This example shows a DNR order for a terminally ill patient in a hospital setting, ensuring their wish to avoid resuscitation is respected during their final stages of life.

An Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) order is a specialized legal document that extends the principles of a DNR order to settings outside of a hospital or nursing home. It is typically issued for individuals who have been diagnosed by a physician with a terminal condition. This order instructs emergency medical personnel, such as paramedics or first responders, to withhold life-sustaining treatments like CPR if the person's heart or breathing stops while they are at home, in public, or in any non-facility setting.

• Example 1: Mr. Robert Lee, who is receiving hospice care for end-stage pancreatic cancer at his home, has an OOH-DNR order. His physician completed the necessary forms, and Mr. Lee keeps a copy prominently displayed. If he were to collapse and stop breathing at home, and his family called 911, the arriving paramedics would see the OOH-DNR order and would not attempt resuscitation, instead providing comfort measures.

  Explanation: This demonstrates an OOH-DNR order for a hospice patient at home, ensuring that emergency responders respect their wish to avoid resuscitation outside a medical facility.

• Example 2: Ms. Sarah Miller, diagnosed with advanced amyotrophic lateral sclerosis (ALS), lives in her own apartment with assistance from home health aides. She has an OOH-DNR order, which she carries with her and has shared with her caregivers. One day, while out for a walk in her neighborhood, she experiences a sudden cardiac event. Bystanders call emergency services. When paramedics arrive, they identify her OOH-DNR order and provide supportive care without initiating CPR, honoring her documented wishes.

  Explanation: This example illustrates an OOH-DNR order for an individual with a terminal illness living independently, ensuring that emergency personnel in a public setting respect their decision to forgo resuscitation.