Community DNR
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A do-not-resuscitate (DNR) order is a request to not perform cardiopulmonary resuscitation (CPR). In other words, it’s a request by the patient not to use CPR. Consequently, interventions that follow CPR like electric shocks to the heart and artificial respirations by insertion of a breathing tube should also be denied or stopped.
In advanced old age, these interventions do not generally succeed. In addition, these interventions are painful to the senior. Pumping on an older person’s chest often leads to broken ribs.
Best practices involving care planning for seriously ill patients encourage doctors to discuss with seriously ill patients the possibility of cardiopulmonary arrest. This is when the heart and breathing stop. Given the condition of the patient, the doctor should describe CPR procedures and likely outcomes, and ask patients about treatment preferences.
In addition, if the patient is incapable of making a decision about CPR, their authorized medical agent can make this decision for them.
Other Names
No CPR. No intubation. Community DNR (EMS)
Purpose
When emergency medical professionals arrive on the scene, it is presumed the patient consents to CPR treatment. If a maker or patient wants to remove this consent, they can use a Community DNR. Community DNRs are for CPR (and may include intubation procedures) outside of hospitals only.
They are also used to give instructions to workers in hospice, nursing homes, and home care environments. They also indemnify emergency responders. In other words, first responders will not be liable for failing to perform CPR.
Limitations
Prehospital resuscitation only.
Who Recognizes
California. Also, a few other states recognize or are considering recognition.
Execution Requirements
Signature requirement: Licensed physician and patient. If the patient is incapacitated, their medical agent can sign.
Revocability
A competent maker (patient) can revoke or modify at any time.
Other Resources For Community DNRs
A good resource on community DNRs here.
Also, see our section on directives here.
