A DNR/DNI or, do not resuscitate or do not intubate order, is a particular type of advance directive.
This document, created alongside a medical professional, is intended for seriously ill or frail people who want to decline life-saving interventions like cardiopulmonary resuscitation (CPR) or breathing machines or tubes if their condition requires such care to sustain life.
Jump ahead to these sections:
- What is Resuscitation?
- What is Intubation?
- When is a DNR/DNI Used?
- How to Request a DNR/DNI
- Why Do People Request a DNR/DNI?
In this article, we break down what DNR/DNI means, when they’re most commonly requested, and why and how a patient requests one.
What is Resuscitation?
The “R” in “DNR” refers to resuscitation. Resuscitation is the act of reviving an individual from near death, like CPR. The medical definition of resuscitation can mean multiple things depending on the situation. It could mean intubation to help sick lungs breathe with a machine. Or, it could mean restarting the heart using chest compressions.
Other methods of resuscitation can include medications to support your blood pressure or blood volume, IV fluids, and cardiac defibrillation.
Defibrillation refers to using a defibrillator to send an electric shock to the heart when the heart is beating out of rhythm, threatening life. Today, many buildings are equipped with automated external defibrillators in case of emergency.
What is Intubation?
Whether or not a patient needs cardiac resuscitation, they may need to be intubated. Intubation means having a flexible plastic tube placed carefully down the trachea, or windpipe. With the tube in place, patients can have air pumped into their lungs manually or mechanically, referred to as ventilation. Intubation also allows the administration of certain medications through the windpipe.
f intubation is deemed necessary, you may be in a medically induced coma. You might also be wide awake and totally conscious, or at any point in between.
Extubation, removing the tube, happens if the patient gets stronger and is able to breathe on their own. Intubation may be a temporary support that can allow the body to heal sufficiently to continue.
When is a DNR/DNI Used?
If you’re suddenly seriously ill or injured from an accident, it’s reasonable and expected for emergency personnel to do everything in their power to save your life. DNR/DNI are most commonly created in special care situations, intensive care or post-operative units, for example.
Depending on the emergency event, like cardiac or respiratory, you may need resuscitation, intubation, or both to be kept alive. If you have a DNR/DNI, you can choose to deny either or both of these interventions.
How to Request a DNR/DNI
A DNR requires a signature from a doctor, nurse practitioner, or physician’s assistant. It's usually a simple, one-page document with checkboxes, signed by the patient or health care proxy. In a hospital setting, it's usually combined with a DNI.
You cannot create a DNR/DNI on your own. If you have an illness with a poor prognosis or terminal condition, a nurse or physician may consult with you to find out what your wishes are in the event of a potentially fatal occurrence.
This consultation doesn’t always happen unprompted, so you should request a conversation about DNR/DNI with your doctor or a member of your care team should you wish.
Why Do People Request a DNR/DNI Order?
When faced with a life-threatening disease or procedure, patients and loved ones must make difficult decisions. Quality of life, finances, and a patient’s personal sense of comfort and dignity may all factor into the decision to request a DNR/DNI.
You may be entering a hospital in a very precarious condition. If you’re about to undergo surgery or other procedure that may not go according to plan, a DNR/DNI can be a way to ensure you maintain your preferred standard of living.
Whether you’ve already had your illness for a long time, you’ve already been given the best, most current treatments available, or, if you’re at a particularly fragile point in the disease, a DNR/DNI may offer a sense of control when your life feels like it is in the hands of others.
A DNR order is something many people choose to keep with other important documents such as:
- Will and estate plan: Your will should include any essential medical documents like a DNR. You can create a free, legal will online in seconds with FreeWill.
- Healthcare proxy: If you have a health care proxy, you should include your DNR with them so they're equipped to make this decision. You can assign a health care proxy with an online legal tool like Trust & Will.
- Emergency contact: Your emergency contact list should also include key documents and health information like your DNR, medical records, etc.
- Emergency plan: If you have an emergency plan, you'll want your DNR just in case. This is something your family should know how to access.
Your important documents are only as useful as they are accessible. Make sure your decisions are heard and understood no matter what.
Should I Think About a DNR/DNI?
The decision to request a DNR/DNI may be a difficult one for you and your loved ones. If you haven’t already thought about your end-of-life preferences, making the decision after an unexpected medical emergency can be even more difficult.
That’s why taking the time to consider your preferences before die. It can make things easier on you and the ones you love when the time comes. If you want to get started today, create a free Cake end-of-life profile and share your preferences with the ones you care about.