Does Hospice Require You to Sign a DNR?
It Depends on the Hospice
Why would anyone refuse to be resuscitated if their heart stopped beating or they stopped breathing? Isn’t CPR always warranted, after all it means a life could be saved? For most healthy people, these are valid inquiries, but the question of whether to have CPR or not gets a little more complex when it comes to the terminally ill.
While requiring a Do Not Resuscitate (DNR) order before admittance is required by some hospices, Medicare-certified hospices do not require a DNR order, since it is understood by the patient and family that the patient will be receiving palliative, not curative, care. VITAS does not require a DNR order before admitting a patient. Whether to be a “full code” patient, which means having whatever measures it takes to save your life or having a DNR order are important aspects of end-of-life planning. Here is some additional information to help you make the most informed decision.
DNR vs. CPR: What to Consider
Today CPR involves more than the commonly known mouth-to-mouth resuscitation and external chest compression of the past. Advances in medicine now allow more aggressive options for saving a life, including electric shock using paddles placed on the chest, open chest heart massage, mechanical assistance from a ventilator and the injection of medications directly into the heart. Additionally, CPR isn’t guaranteed to work and sometimes leaves the patient in worse condition than before.¹
What Is a DNR Order?
Do Not Resuscitate means exactly that. It is an order written by a physician and placed in the medical chart that instructs all medical staff not to try to revive a seriously ill patient in the event their breathing or heartbeat stops. This means physicians, nurses and others, including emergency medical technicians, will not initiate any emergency life-saving procedures. Generally, a DNR order is placed in a seriously ill patient’s chart before a medical crisis occurs.
The Pros and Cons of CPR
The number one pro of CPR is that it can save your life. For individuals who are choking, drowning, having a heart attack or when blood flow to the brain is interrupted for any reason, every minute counts. Immediate CPR can prevent permanent brain damage. When CPR is successful, it can keep damages to a minimum by quickly restarting the heart to get blood flowing again. CPR is most successful on individuals who are healthy—whose bodies are not compromised by the frailness of advanced age, illness or disease.
On the other hand, CPR can be difficult for the body to withstand. External chest compression can cause cracked or broken ribs. Contusions to the lungs from the force of CPR can leave the patient on a ventilator. CPR administered too late or incorrectly can leave a patient brain damaged or dead. Even mouth-to-mouth resuscitation can spread disease, especially if the patient is immunocompromised.
VITAS and DNR Orders
There’s no right answer to whether a seriously ill patient should be revived if their heart or lungs stop working. Some people may never be ready to forego CPR and will have this noted in their medical records. Others see a DNR order in their chart as assurance they will die a natural death when the time comes. Still others don’t make a decision, leaving it up to distraught family members to decide in a crisis situation. While some hospices may require a DNR before admittance, VITAS does not.
The best-case scenario is to talk with your family about what you would want long before you actually need to. Having advance directives in place takes the burden of making this and other crucial end-of-life decisions easier on everyone involved.
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