What Is a DNR Order? How Does It Work?

Posted By Jay Kaufman || 1-May-2012

For Clients, Community and Advisers. I am often asked about the mechanics of implementing a DNR (Do Not Resuscitate) Order. Many elder or infirm clients do not want to spend their last months dragged through extraordinary medical procedures. Rather, they choose to have a natural death without having the medical establishment bring out the paddles every time they arrest or have breathing trouble. There is a pronounced tendency toward a nuanced and calm end, at home with loved ones – not in a hospital with a sterile environment.

In our practice, we always offer our clients a durable power of attorney for health care as part of their estate plan. (In Illinois, normally do not use the “living will” as its equivalent provisions are included as part of the durable power of attorney for health care. In other states including Florida and Wisconsin, it is different.) Many of our older clients come in to the office asking that we include a DNR order in their power of attorney. What is a DNR order and how does it work (under Illinois law)?

There was a new DNR order form developed by a task force and issued by the Illinois Department of Public Health in 2005. It requires the signature of the patient (or his /her legal representative such as an agent under power of attorney if he or she in incapacitated and cannot make a decision or sign) and a witness. To be valid, it must be signed by the patient’s physician. The physician’s signature is required not for consent, but rather to ensure that patients are getting appropriate counseling concerning a critical life and death decision.

There are basically two options. The first is whether or not CPR should be attempted in the event of cardiopulmonary arrest. Typically, for an individual who wants a valid DNR order, the answer would be, “no”. (Do No Rescusitate) The second is whether or not CPR should be attempted in the event of a pre-arrest emergency (when breathing is labored or stopped, but the heart is still working). Here, the answer could be yes or no.

In appropriate circumstances, we will prepare the DNR paperwork for our estate planning clients as well as those clients who are members of our Family Lifetime Care Program (our continuing service program. For more information, call me). It is important to keep in mind, however, that a valid DNR requires a physician’s signature. The DNR order should be completed well in advance of any emergency. A copy of the document should be kept in your medical record with your physician, the hospital you normally use and a copy handy in your home for any emergency.

End of life care decisions are always sad and often difficult. Nonetheless, all of us need to face them at some time. Planning makes this task much easier for each of us when our time comes; but also for our families and our loved one.

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