End-of-life planning is essential for ensuring your medical wishes are respected when you cannot communicate them yourself. Two critical documents in this planning are Do Not Resuscitate (DNR) orders, including Do Not Resuscitate Orders Outside the Hospital (DNRO), and living wills.
Understanding the DNR form and how it fits into your overall healthcare plan is crucial. Although both documents deal with medical care preferences, they serve different purposes and are used in distinct situations.
This blog will explore the key differences between DNR/DNRO and living wills, providing clarity on their functions, implications, and importance.
What is a DNR/DNRO?
A Do Not Resuscitate (DNR) order is a medical directive from a doctor instructing healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops beating or if they stop breathing. The primary purpose of a DNR is to prevent unwanted and potentially invasive resuscitation efforts that may not align with the patient’s wishes or may not provide a meaningful quality of life.
A Do Not Resuscitate Order Outside the Hospital (DNRO) is a specific type of DNR that applies to situations outside of hospital settings, such as in the patient’s home, a nursing home, or during transport by emergency medical services (EMS). This order ensures that the patient’s wishes are respected in non-hospital environments where immediate resuscitation efforts might otherwise be initiated.
What is a Living Will?
A living will is a legal document that outlines a person’s preferences regarding medical treatment in situations where they are unable to communicate their decisions due to incapacity or severe illness. Unlike a DNR, which focuses specifically on CPR, a living will covers a broader range of medical interventions and treatments. These may include decisions about the use of mechanical ventilation, tube feeding, dialysis, and other life-sustaining measures.
A living will come into effect only when the individual is incapacitated and cannot make or communicate decisions. The document provides guidance to healthcare providers and family members, helping to ensure that the patient’s wishes are followed even when they cannot speak for themselves.
Key Differences Between DNR/DNRO and Living Will
Here, we explore 5 key differences between DNR/DNRO and living wills.
Scope and Specificity
DNR/DNRO: A DNR/DNRO is highly specific in its scope. It addresses only one medical intervention—cardiopulmonary resuscitation (CPR). The directive is clear: if the patient’s heart stops or if they stop breathing, no resuscitative efforts should be made.
Living Will: A living will, on the other hand, covers a broad range of medical treatments and interventions. It provides detailed instructions on various life-sustaining measures beyond CPR, such as mechanical ventilation, artificial nutrition and hydration, dialysis, and pain management. This comprehensive nature allows individuals to express their preferences about multiple aspects of their care.
Applicability and Activation
DNR/DNRO: A DNR/DNRO is activated only under specific circumstances—when the patient experiences cardiac or respiratory arrest. It is a medical order that healthcare providers are required to follow once it is in place.
Living Will: A living will become applicable when the individual is incapacitated and unable to make or communicate decisions about their medical care. This could be due to a terminal illness, severe injury, or a permanent state of unconsciousness. The living will guide healthcare providers and loved ones in making decisions that align with the patient’s wishes in a variety of scenarios, not just cardiac or respiratory arrest.
Creation and Documentation
DNR/DNRO: A DNR/DNRO must be written and signed by a physician. The process usually involves a discussion between the patient (or their legal representative) and the doctor about the patient’s wishes and medical condition. The order is then documented in the patient’s medical records and, in the case of a DNRO, may be carried by the patient or displayed prominently in their home.
Living Will: A living will is created by the individual, often with the assistance of an attorney from Elder Needs Law PLLC. It is a legal document that must be signed and witnessed according to state laws. Unlike a DNR/DNRO, it does not require a physician’s signature but should be shared with healthcare providers to ensure that it is accessible when needed.
Legal and Ethical Considerations
DNR/DNRO: Because a DNR/DNRO is a medical order, it carries significant legal weight and must be adhered to by healthcare providers. Ethically, it respects the patient’s autonomy by ensuring that their wish to avoid resuscitation is honored.
Living Will: A living will also has legal standing and is a crucial component of advance care planning. It upholds ethical principles by ensuring that the patient’s broader healthcare preferences are respected, promoting autonomy and dignity.
Context of Use
DNR/DNRO: DNR orders are primarily used in hospital settings, while DNROs are designed for use in non-hospital settings. DNROs are particularly important for patients who wish to remain at home or in a non-hospital facility and avoid aggressive resuscitative measures.
Living Will: A living will is relevant in any healthcare setting, providing guidance for a range of medical treatments in hospitals, nursing homes, or at home. It is a versatile document that applies wherever the individual might receive care.
Conclusion
Understanding the differences between DNR/DNRO and living wills is crucial for effective end-of-life planning. A DNR/DNRO addresses the decision to forgo CPR during cardiac or respiratory arrest, providing clear guidance to healthcare providers.
In contrast, a living will offer comprehensive instructions on a range of medical treatments and interventions. By incorporating both documents into your advance care planning, you ensure your medical wishes are respected in various scenarios, giving peace of mind to you and your loved ones.
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