Could it be that if a patient has already decided to not continue their life by turning down resuscitation legally, healthcare professionals should save time and money by not recommending or performing surgeries to prolong life? A new study shows that about 70% of Americans die when they have do not resuscitate (DNR) orders in place, after having potentially saving surgeries or not.
Dr. Saziana Roman, who worked on the study comments:
“The conversation that needs to be had between the patient and the doctor is, what is the greater goal, and what can you expect from having the surgery. Are you likely to end up on a ventilator or in the intensive care unit, for instance?”
Researchers contrasted the surgical outcomes for some 4,000 DNR patients with age-matched patients who’d had the same procedure done but didn’t have a DNR order. Overall, nearly 25% of DNR patients died in the month following their surgery, about three times as many as in the comparison group. That difference remained even after taking into account that DNR patients are usually sicker to begin with, Roman said, although the reasons aren’t clear.
DNR patients also had slightly more complications, such as pneumonia or stroke. Roman added:
“In U.S. there is a tendency to be afraid to talk about dying, and we are trained to value life above anything else. Sometimes that might actually be detrimental.”
A DNR order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patient’s breathing or heartbeat stops.
DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to revive the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR.
CPR, when successful, restores heartbeat and breathing and allows patients to resume their previous lifestyle. The success of CPR depends on the patient’s overall medical condition. Age alone does not determine whether CPR will be successful, although illnesses and frailties that go alone with age often make CPR less successful.
When patients are seriously ill or terminally ill, CPR may not work or may only partially work, leaving the patient brain-damaged or in a worse medical state than before the heart stopped. In these cases, some patients prefer to be cared for without aggressive efforts at resuscitation upon their death.
In 1991, the U.S. Congress passed into law the Patient Self-Determination Act that mandated hospitals honor an individual’s decision in their healthcare. Forty-nine states currently permit the next of kin to make medical decisions of incapacitated relatives, the exception being Missouri.
In the United States, CPR and advanced cardiac life support (ACLS) will not be performed if a valid written DNR order is present. Many U.S. states do not recognize living wills or health care proxies in the prehospital setting and prehospital personnel in those areas may be required to initiate resuscitation measures unless a specific state sponsored form is appropriately filled out and cosigned by a physician.
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Written by Sy Kraft