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What Is a DNR?

Ever wondered about a DNR and how it differs from a DNI? Here’s what I tell my patients and their families.

When someone suffers a serious, chronic illness such as cancer or Alzheimer’s disease, a time may come when they need palliative care or hospice care.

Palliative care aims to provide relief, maximize the quality of life for patients and caregivers alike, and potentially lead to a cure. On the other hand, hospice care offers comfort when a cure is impossible.

While making choices about end of life and quality of life, an individual — together with family members and medical professionals — must decide when to stop medical treatments. To guide this decision, many create a care plan that includes a do not resuscitate (DNR) order.

‘Do Not Resuscitate’

Resuscitation means reviving someone from unconsciousness using cardiopulmonary resuscitation (CPR).

Doctors create a DNR order when someone doesn’t want to be resuscitated. A DNR order states that an individual does not want to be given CPR should their breathing stop.

Without a DNR, it’s assumed that individuals who stop breathing desire CPR. While CPR brings up visions of mouth-to-mouth breathing and quick chest pumps, CPR techniques also include:

  • Administration of specialized medication
  • Restarting the heart with electric shock
  • Use of breathing tubes to open the airway

Who creates a DNR order?

A medical doctor writes a DNR order.

The order must be recorded before a life-threatening or -changing emergency occurs. This ensures the individual seeking a DNR is thinking clearly.

In some cases, a health care proxy helps develop the DNR. Also known as medical power of attorney, a healthcare proxy makes medical decisions for someone else.

Most often, a family member, such as a child or spouse, takes the role of proxy. A proxy may also be a close friend.

The health care proxy knows the patient’s medical wishes. They help ensure healthcare professionals follow their loved one’s desires.

Understanding a DNI

While a DNR is a do-not-resuscitate order, DNI means do not intubate.

When a patient is intubated, medical professionals insert a thin tube down the throat and into the trachea. A machine called a ventilator pumps air through the tube, providing oxygen to the lungs when they struggle to work properly.

This keeps people alive and helps sick individuals overcome breathing problems. Though an amazing life-saving advance, not everyone welcomes intubation.

Some people prefer to not be kept alive on a ventilator. These individuals should create a DNI order.

As with a DNR, a DNI ensures loved ones and medical professionals know an individual’s wishes.

DNR vs. DNI

Trying to figure out whether to use a DNR or DNI?

Understanding the scope and limitations of each will help people choose the one that fits their needs. Someone who wants no efforts made to resuscitate them should choose a DNR.

This prevents medical intervention in the event their heart or lungs stop working. When an individual does not have a pulse or has stopped breathing, a DNR keeps medical personnel from performing CPR, including intubation.

Less restrictive than a DNR, a DNI allows medical intervention up to a point. Should someone stop breathing or their heart stops beating, their healthcare team can still administer chest compressions, medication or other therapies.

A DNI only prevents intubation.

Planning for tomorrow

Some people struggle with whether to have a DNR or DNI.

Fortunately, an individual can change their mind. If their health status changes, they can exchange a DNR for a DNI or vice versa.

They can also do away with the order altogether. To make end-of-life decisions easier for family members, people should talk with their loved ones.

Discuss wishes about quality of life and resuscitation. Appoint a healthcare proxy.

And to make decisions even easier, include a DNR in an advance directive or will. This helps loved ones know what to do when they can’t express their desires out loud.

Looking for palliative care? Tanner Health System’s compassionate team is here to help.

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