Doctors are trained to do everything in their power to save a patient’s life in a dire emergency, and bystanders are likewise tasked in many cases to perform CPR on an unconscious individual. But what happens when the patient doesn’t want to be subjected to aggressive lifesaving measures? Can you perform CPR on someone with a DNR? And how do you know they have a DNR in place to begin with? When it comes to performing CPR on a DNR patient, the answers can be a bit complicated.
What Is a DNR?
A DNR is a do-not-resuscitate order. A person will designate this order for themselves before an emergency occurs. If you opt for a DNR order, you’re establishing to your family and to medical personnel that you do not wish to receive CPR in an emergency. A DNR doesn’t include guidelines for administering medication or nutrients; it only applies to resuscitation.
In order to establish a DNR order, you need to speak with your doctor. The doctor will discuss your options with you and your family and help you to understand what the order entails. Then, if you decide to proceed, the doctor will write the order for you. The order becomes a part of your medical record, and any medical professionals who treat you in a clinical setting are required to abide by the order.
A DNR form is intended to inform medical professionals and hospital staff, but it has implications outside the hospital as well. For instance, nursing homes and assisted living facilities often use pre-hospital DNRs to determine how to treat patients in a cardiac arrest situation.
Why Do People Choose to Have a DNR?
Approximately 80% of people receiving end-of-life care do not want to be subjected to aggressive measures that may or may not prolong their life. These measures can be painful and invasive, and they don’t significantly increase a patient’s chances of survival. When the measures are successful, they often come at the expense of the patient’s quality of life.
By default, emergency services professionals will do everything possible to resuscitate a patient regardless of their existing health or prognosis. A DNR allows the patient to acknowledge that they’re nearing the end of their life and express that they would rather let nature take its course when the time comes.
Does a DNR Order Apply to Defibrillation?
Some websites will tell you that a DNR applies only to CPR, but it’s a little more complicated than that. A do-not-resuscitate order applies to cardiac resuscitation in a more general sense, which includes chest compressions, rescue breathing, and defibrillation.
Consider the DNR Protocol established by the Ohio Department of Health as an example:
…Emergency care and other health care providers…WILL NOT administer chest compressions, insert an artificial airway, administer resuscitative drugs, defibrillate or cardiovert, provide respiratory assistance (other than suctioning the airway and administering oxygen), initiate resuscitative IV, or initiate cardiac monitoring.
So if a patient has a DNR order in place, emergency services will refrain from using a defibrillator, as this equipment is designed to restore cardiac function.
How Can You Know if Someone Has a DNR?
A person with a DNR may have a bracelet or tattoo with the letters “DNR” or the words “Do Not Resuscitate.” If it’s a tattoo, you’ll usually find it on the person’s wrist, forearm, or chest. You should always check before performing CPR.
If you don’t see a bracelet, tattoo, or other evidence of a DNR, you have no reason to suspect that the individual has such a directive in place—unless you’re specifically told of a DNR by somebody in their company.
Can You Get Into Trouble for Performing CPR on a DNR Patient?
DNR orders are designed primarily for doctors and caretakers, but bystanders may be affected as well—particularly if the individual has a bracelet or tattoo that alerts the public of their wishes. If you encounter this type of identifier on a cardiac arrest sufferer, you’ll need to decide whether or not to take lifesaving action.
In the event that you do decide to perform CPR on someone with a DNR, you’ll usually have some protection from Good Samaritan laws. These laws are intended to encourage bystanders to act in an emergency without fear of legal or criminal reprisal. So if you see an unconscious person on the sidewalk and you decide to perform CPR and external defibrillation despite noticing a DNR bracelet on their wrist, you’ll usually be protected—even if the patient doesn’t ultimately survive.
For example, California Health and Safety Code §1799.102 specifies that “No person who in good faith, and not for compensation, renders emergency medical or non-medical care at the scene of an emergency shall be liable for any civil damages resulting from any actor omission commonly known as ‘The Good Samaritan Law.’”
There are exceptions to the rule, of course. Most Good Samaritan laws won’t protect bystanders who act in a willfully reckless or negligent manner. So if you cause injury due to improperly administered CPR or defibrillation, or if you try to defibrillate someone who wasn’t experiencing cardiac arrest in the first place (cardiac arrest and heart attack are often confused for one another), you may still face liability. Before you proceed, it’s important to know how to perform CPR properly.
The good news is that publicly accessible defibrillators provide CPR coaching and are designed to minimize the risk of injury. For instance, the Defibtech Lifeline AED relies on a simple two-button operation and provides calm, clear CPR coaching. It uses biphasic waveform technology to assess heart rhythms and recommend shocks only if they’re advisable for the patient.
In addition, while all 50 states have some form of Good Samaritan law on the books, the specifics of the law can vary from one jurisdiction to the next. So it’s a good idea to research the specific law in your state and speak with a legal representative if you have any questions.
In a cardiac arrest emergency, every second matters. So in the rare event that you do encounter a patient with a visible DNR, know that you shouldn’t be negatively affected by any good-faith actions intended to keep the patient alive while you wait for emergency services to arrive.