I can’t find this answer online??
AIUI, a DNR has the implied, if not stated condition that the patients condition is terminal, with little chance of meaningful recovery…
I’m confused by what you mean “on file”. The only time I’ve known someone to have to “file” a DNR, was when the hospital demanded that someone have advance directives in case of a problem. Even then, it wasn’t filed with the hospital, a form was signed saying that the patient had complied. Usually the families, friends, lawyers are the ones with the DNR , or maybe an eldercare advisor.
I guess my question is how would any given hospital know that my spouse is holding a DNR and Advanced Directives for me if he doesn’t tell them?
The VA asked that we put the one we already had on file with them. We complied. We did medical directives and medical POA as a part of our trust years ago as we are not married.
The POA was critical to me as again, we are not married.
My understanding is it means if there is NO hope of recovery the DNR is put into practice.
I’ve signed them twice for separate events. They don’t necessarily carry over. This was a private hospital.
YMprobablyV. The VA is different.
ETA- if a ventilator is necessary for life and there’s no hope of recovery you will not get one. IMO
And that’s my issue, hearing that <old> people, with underlying conditions are not expected to do well with this…I mean where is the determination made? "Oh, he’s 71, with a DNR. I am NOT suggesting that that’s how it works, and when we signed them (we both have them) Covid and overcrowded hospitals and a shortage of equipment was not exactly driving our decision making. But now I just wonder.
This is why I take sleeping pills now, I swear to og
In most cases, “DNR” means do not resuscitate, which means that if the person’s heart stops, no measures are to be taken to restart it. This does not apply to mechanical ventilation, although a patient does have the right to refuse it if they don’t want it, and that doesn’t just apply to COVID patients. Quadriplegics, people with ALS, people with other terminal conditions, that kind of thing.
If you were to acquire symtoms of the virus where would you go?. To your Doctors office? The E.R.? The VA?
I don’t imagine your VA file will be looked into at a local hospital. If you had to wait on a VA appointment you’d probably die waiting, anyway.
Well, VA is different. I really don’t know much about that at all. I wonder if you could now put a “Give me a stinking vent!” on file?
I have a friend who is an ER PA at the Phoenix VA center. He says there are fewer people seeking treatment there because people are afraid to go to the hospital. Ambulances aren’t taking COVID cases to the VA, they are going to other hospitals.
That is just hearsay from a facebook post from last night.
Thanks you nearwildheaven. Beckdawrek, in spite of what you may have heard, we get superb care at the VA and never wait for anything urgent. They are angels for us.
They have set up triage at the Phx VA. They are taking patients. He has a service related injury from Viet Nam. We would go to the VA. We get almost daily communications from them.
Oh, well if they are triaging then that’s the place to go. Just tell them you’ve changed your mind. Surely there’s a way to do that.
When I signed my last one they gave me several opportunities to change it before my surgery. I specifically did not want a vent. I spent some time on one once. I’d rather die, it was horrible. Of course I had the vent during the operation but it was out before I came awake.
I was asked to file my Advanced Directive when I first had surgery at a hospital. Now if I go in for a procedure at this hospital, they ask if it is on file with them already.
Not automatically.
DNR means “do not resuscitate”, not “do not intubate”. If your heart stops they won’t try to restart it, but a DNR does not rule out other measures to sustain life as long as your heart is still beating.
Why you have a DNR might factor into medical decisions - if you’re at the end of a terminal illness there might be no point in putting you on a ventilator, as an example. But if you undergoing an elective surgery and didn’t have a soon-to-be-terminal condition, as an example, there is no reason NOT to put you on a ventilator for the duration of the surgery. Or you might be intubated for severe pneumonia even if you do have a DNR, it’s just that if your heart stops during that treatment they won’t be trying to re-start it. If your heart keeps going during your time on ventilator you might get better, recover, and live many more years.
Advanced directives can become quite specfic - my mother carried a DNR in her purse for something like 20 years, and also added specifically a DNI (do not intubate) to it as well. During that time she certainly did undergo medical treatment, including treatment for a stroke. So it’s not a “give up on the patient” order.
I signed my DNR where my doctors have admitting, where it is kept on file. I also got a wallet card that indicated which hospital has it on file.
There are different things, I know from having two parents who were terminal with cancer. There’s the DNR, then there’s “No heroic measures,” and there’s “palliative care only.”
On my father’s last day of life, he could not be roused, but his heart was beating, and he was breathing. He was on oxygen (not a ventilator, just the nasal cannula), and had been on it as a palliative measure since before he became unconscious. I got a call in the morning, because the nurses couldn’t reach my mother, who was doing something for herself for the first time in a week. They wanted to know if they should start IV fluids, because the oxygen could be dehydrating, and they couldn’t wake him to take any fluids by mouth.
“So, he’s not conscious.”
“No.”
“Do you think he’s experiencing discomfort from being dehydrated?”
“No.”
So I said “No,” to the IV, but told them to ask my mother again when they got hold of her. Now, if he’d been conscious, say, with eyes open, but not able to communicate, somehow-- not making sense, for example-- the answer about discomfort probably would have been different, and I would have said “Yes” to the IV.
When my mother was “Palliative care only,” they removed all heart and pulse ox, etc. monitors from her, because none of that mattered. They did not need to monitor those things if they were not going to react to emergent situations, and she was more comfortable without them. She was in hospice, though, not a hospital. Hospices can probably not do things that hospitals may be required to do.
Anyway, DNR is the “least” for lack of a better word, of the different “let me go” orders you can have. As long as your heart is beating, they will do everything to save you. They will even defibrillate. That happened to my father when he was terminal, because he was not yet “palliative care only.” He WAS DNR, though, and my mother was surprised they defibrillated. After that, there was a sign on his bed that said “DNR-- NO DEFIB.” So that apparently had to be specified.
Now, I’m not sure if the rules are different now, because hospitals are overcrowded. You should probably ask. But I do know that you can rescind a DNR.
I know this story 2nd hand, but apparently a woman of my acquaintance had an extremely radical surgery for ovarian cancer-- they removed practically everything from her diaphragm to her pelvis-- and she was DNR during and immediately after that surgery. However, it worked, and two years later, she was not DNR when she was in the hospital for something minor.
But, I don’t see why you shouldn’t be able to rescind a DNR. Statuses do change. Someone waiting for a transplant might be DNR, but then get a match, and after the transplant, rescind the order. A lot of people with HIV were probably DNR in the 90s, but if they were lucky, and made it to the 00s, and the meds of that era, they probably rescinded.
Having sleep apnea, I asked about respeiratory support with a DNR last time I was in hospital. They assured me DNR would only apply if there was no chance of ever breathing on my own, or I was hrain dead. This was nurse lebel info. The hospital lawyers might have a different view.
To the OP: Do you mean an advance directive (a.k.a. living will), or an actual DNR order?
You can certanly rescind a DNR order at any time. You can also specify intubation/no intubation, and feedings and IV fluids separately. The California POLST system is a good example https://capolst.org/
If you mean do hospitals, during the current crisis, consider the presence of a DNR as part of their algorthim for who gets a vent, either officially or not, I don’t know. On the one hand, people progressing to ventilators with covid are not doing well, AIUI, on the other hand a person can survive for years with a DNR inplace and not be at greater risk for covid than the general population.
DNRs are widely misunderstood.
Most states have statutes that spell out what it takes to be qualified for wearing a DNR bracelet, and to have a DNR order. Generally it’s required that some sort of terminal condition is present that’s more likely than not to result in death in a year or less, or to suffer a condition that would make it futile and cruel to attempt resuscitation. If two physicians sign off on it, then the order is active and the bracelet is placed. But a patient can revoke it and remove the bracelet at any time.
Most folks with active DNR orders aren’t interested in being on a vent, but there are exceptions.