Episode 23: The 7-Minute Scoop: Do I need a DNR?

In this 7-Minute Scoop, Mitch discusses the often debated DNR, or Do Not Resuscitate, order.  He explains what it really means to sign a DNR, and what it doesn't mean.   

Transcript

Welcome to another  7 Minute Scoop brought to you by Living With Hospice. I'm Mitch Ware, and it's an honor to be with you today. 

If you've read the hospice or end of life forums on social media, there seems to be a buzz lately about DNR orders.  That's - Do Not Resuscitate. What is the DNR? Well, we're going to get into that today.  We're going to talk about what it is and what it isn't. There just seems to be a lot of confusion about what it means exactly what it means and if it's required in a hospice setting. So, that is what we're going to tackle today. Glad you could join us. 

For many people, just the mention of DNR is really upsetting. When health care professionals speak to patients and family members about a DNR, all too often,  the family believes they hear, "we're going to abandon care and stop all treatment." The negativitism confuses many people who think that approving a DNR order gives medical staff permission to terminate their loved one's life. Or they may be reluctant to agree to the order because, well, they feel guilty that they're not doing everything that they can to help their loved one as they feel that they should to them. It's a feeling of giving up and I get that. I too was at that point in my thinking at one time. I think a lot of the reservation revolves around pretty much a basic misunderstanding of what a DNR actually is. So, let's start with what the heck is a DNR. 

By definition, a DNR is a legal medical directive that states if your heart stops, or you stop breathing, you do not want to be brought back to life via CPR or having a tube stuck down your throat or being intubated in any way. Certainly not attached to a ventilator, which is basically a breathing machine in order to be kept alive. Simple as that. Nothing more, nothing less. That's exactly what it is.

Well, okay, Mitch, so is a DNR required by law for hospice patients? 

No, it is not a requirement by law, Medicare nor Medicaid require a DNR

Okay, so can hospice and other agencies require these? 

Yes, they can. And yes, they do. It's not a matter of law, but it's a matter of company policy for most all hospice organizations these days. 

If people are going to hospice to pass away, why then do these agencies require these DNR s? They're dying anyway? 

That's a great question and I hear it a lot, or at least I've read it a lot lately. The answer is your hospice agency does not want to get into a legal or moral argument in or out of court. Court over whether someone should be necessitated. And CPR by the way is a very violent procedure. It's not like they show you on TV. For many who are in hospice. This procedure alone could cause death. For example, somebody with osteoporosis could experienced a shattered rib or three or five during this procedure. Well puncture along or worse. Did you know that CPR involves more than the commonly known mouth to mouth resuscitation and external chest compressions? Advances in medicine now allow much more aggressive options for saving a life including the electric shock that we've seen those paddles are they say clear and then they zap somebody's chest? Well, there's also other measures to like open chest heart massage, mechanical assistance from ventilators and the injection of medications directly into the heart. Additionally, CPR isn't guaranteed to work sometimes leaves a patient in worse condition than before. And quite frankly, for someone who's terminally ill and very frail, and has been in hospice for a while, well, from where I sit, it's not a good choice. S that's why hospices have that DNR policy in their company. So most hospices do. 

Okay, Mitch, so my hospice agency requires that I sign a DNR but I'm still uncomfortable about it. I don't know why, but I'm just not sure I want to sign on to that. What are my options? 

Well, you can always leave that hospice, but I don't recommend it. it as much as pretty much any other hospice you go to is going to require the same thing. Moreover, look at why you don't feel comfortable about the DNR. Remember what a DNR really is, remember that it's probably not what you thought it was. It's simple. When the heart stops or breathing stops, your loved one does not want to be brought back to life through CPR, or by having a tube stuck down their throat to be intubated and attached to a ventilator or a breathing machine to be kept alive. 

It's nothing to do with some of these rumors and anecdotal pieces of information flying around about, well, we're gonna stop feeding them or we're going to take away all their medicines or we're going to take away their water or their their fluid intake or anything else. It's simple.  

Their heart stops, or they stopped breathing. They will not have CPR administered, nor will they be put on a ventilator. So, again, from where I sit, there's no reason not to sign DNR. 

So Mitch is a DNR Good idea. It seems to me that's what you're saying?

Well, I can't speak for you. That's a decision that only you can make. You have to weigh that out for yourself. There are moral as well as practical issues to consider. It's something that you should consider and have put into your advanced medical directive. 

So in summary, do we need a DNR to be in hospice? Well, it's not a requirement by law, but it is probably a requirement by policy from your hospice agency. Just look at what your hesitation is, Why are you hesitating? flesh those feelings out, and then look at what a DNR really is. Remind yourself in and then realize, bring it forward in your mind what it isn't. And hopefully you'll find peace in your decision. 

As always, thank you for listening. Please let us know how we're doing. By the way, leave us a comment or subscribe to our podcast. That's even better. That way you won't miss a single one. So there you have it. Another Living With Hospice, Seven Minute Scoop.  I'm Mitch Ware.  Have a blessed day!