End-of-Life Choice, Palliative Care and Counseling

Do You Want a Resuscitation Attempt?by Pat Tucker

Back

            “Do Not Resuscitate.”  Doesn’t that order in a hospital chart mean you’re going to die? Doesn’t it mean doctors won’t prescribe medicines that may keep you alive? Wrong on both counts. “Do Not Resuscitate (DNR)” means only that should your heart stop, there will be no attempt to restart it with cardiopulmonary resuscitation (CPR). All other types of appropriate care and intervention are continued for patients that have DNR orders. Many patients with DNR orders recover, go home and live long lives.

            There are good reasons for having a DNR order even when a person is not terminally ill. The odds of surviving an in hospital resuscitation attempt are not great, even for healthy people. Only about 15% do. When old age, frailty, or multiple medical problems are present the odds go down significantly. Only 1 to 2% of this population survives long enough to leave the hospital. Of those leaving the hospital, even fewer leave without significant problems associated with the attempt. According to an article in Neurology, major brain damage occurs more than 50% of the time (Jaffe, AS. Neurology, 1993: 43:2173).

            CPR outside a hospital is even less successful. A less than 5% survival rate is common in many areas. Even in the best scenarios (immediate help by a trained bystander) only 19% of those who survived out of hospital CPR efforts did so without brain damage . Yet, as I noted in a previous blog, a living will and/or advanced directive asking that resuscitation not be performed is not adequate in many states. If you do not want CPR you must find out how your state regulates this!

            Just because there is an 85% CPR survival rate on our favorite television shows doesn’t make it so. It’s important that we all understand the facts about CPR. If you decide that CPR is not in your best interests, discuss your wishes with family members and your physician and make sure that the proper documents your state requires are completed. Requesting a DNR order is not giving up. It is not saying you want to or are ready to die. By itself it simply means that the odds of a successful attempt do not meet the criteria you have for quality of life. You have a right to determine what that means for yourself.