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
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.