Stories of hospitals being subjected to civil litigation for failing to intervene or, alternately, for wrongfully intervening to resuscitate a patient using advanced life support are quite common. These unfortunate incidents typically have at their core three central figures:
- A dying patient;
- The dying patient’s family; and
- A healthcare professional who misunderstands the meaning of the term: “do not resuscitate.”
What Does “Do Not Resuscitate” Actually Mean?
The term “Do Not Resuscitate” (also referred to by its acronym DNR) means that a patient should not receive cardiopulmonary resuscitation (CPR) in the event of cardiopulmonary arrest. This is a situation where the patient is unresponsive, has no pulse and is not breathing (i.e. they have died).
Vague Terms Creates Confusion
Unfortunately, a wide array of healthcare providers and patients misinterpret a DNR order to mean that no life support should be given when there is evidence of clinical deterioration. Basically, this is a fancy medical term meaning a patient has not yet died but is rapidly getting sicker. In other instances, someone will mistakenly interpret a DNR to mean that there should be no intubation in order to place a patient on a breathing machine when their oxygen level plummets.
There is also concern that if someone has a DNR, it may result in reduced medical care in general. For example, a recent survey of more than 500 internal medicine residents revealed that doctors were less likely to pursue aggressive or invasive medical treatment when a patient had a DNR order in place, according to a great article published on The Hill.
Progression of Medical Terminology Highlights Need for Change
The evolution of medical terminology contributes to misunderstanding. CPR was first introduced in the 1960s and became standard of care for cardiopulmonary arrest. In the mid-1970’s, concerns that universal CPR might cause more harm than benefit for some patients led hospitals to develop policies allowing patients to forgo CPR, described as “orders not to resuscitate.”
In the 90s, the term “resuscitation” started appearing in medical literature to describe strategies to treat people with reversible medical conditions, such as IV fluids for shock from bleeding or infection. As the medical terminology surrounding treatments designed to intervene before arrest might occur effectively appropriated the term “resuscitation,” an unintended consequence is that the term “DNR” became ever more confusing to healthcare providers, patients, and their loved ones.
In an effort to try and address these misunderstandings, the Physician Orders for Life Sustaining Treatment (POLST) paradigm actually separated CPR from other forms of life-sustaining medical treatments. For example, POLST describes CPR as only being necessary “when the patient is unresponsive, has no pulse and is not breathing. This is similar to a do not resuscitate order, but a patient only has a DNR Order when they do not want CPR.”
Now is the Time to Re-Brand DNRs
An initiative is afoot to try and modify the terminology surrounding DNRs. Some people have suggested modifying the term to “Do Not Attempt Resuscitation” (DNAR) or “allow natural death” (AND). Another option is for a patient to have a document that simply states “No CPR.” The ability to designate a preference against CPR would make it more transparent to patients, families and medical providers what treatment, exactly, the patient wants withheld.
A full-on re-branding of DNRs would likely create administrative burdens for the state governments, hospitals, nursing homes, etc. needing to modify statutes, policies, forms and information technology. Nevertheless, healthcare systems make these types of modifications quite frequently. For example, the United States recently adopted a new diagnosis and treatment code categorization system in order to improve billing detail, which is expected to cost in excess of one billion dollars to fully implement. Officially eliminating DNRs from medical lingo and replacing it with a more appropriate term such as “No CPR” or “Allow Natural Death” is just as worthwhile.
Have Questions About Your End-of-Life Care? Contact an Experienced Trust & Estate Planning Attorney with InSight law
The decisions concerning end-of-life care, including whether you prefer to be resuscitated, are extremely personal and should be respected by family, friends, and medical professionals. That is why it is important to retain the services of the right estate planning attorney who is able to explain your options and clearly communicate your preferences to your healthcare agent. A skilled and knowledgeable attorney can also help train your healthcare agent on how to communicate your preferences to healthcare providers. This is what effective counseling is all about. The legal team at InSight Law provides these services, and many more. Schedule a meeting with one of our team members today.