Do-not-resuscitate (dnr) orders and physician orders for life-sustaining treatment (polst)

[Jason Yan]

The do-not-resuscitate (DNR) order placed in a patient’s medical record by a physician informs the medical staff that CPR should not be done in the event of cardiac arrest. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life.
Physicians discuss with patients the possibility of cardiopulmonary arrest in light of their immediate medical condition, describe CPR procedures and likely outcomes, and ask patients about treatment preferences. If the patient is incapable of making a decision about CPR, a surrogate may make the decision based on the patient’s previously expressed preferences or, if such preferences are unknown, in accordance with the patient’s best interests.
Living wills and durable powers of attorney for health care are not typically available in emergency situations and thus may be ineffective. Almost all states have specialized DNR protocols or a POLST program for patients who are living at home or in any nonhospital setting. DNR protocols typically require the signing of an out-of-hospital DNR order by both the physician and patient (or the patient’s surrogate) and the use of a special identifier (eg, a bracelet or brightly colored form) that is worn by or kept near the patient. If emergency medical personnel are called in case of emergency and see an intact identifier, they will provide comfort care only and not attempt resuscitation. These protocols are important to know because, normally, emergency medical technicians are not expected to read or rely on a living will or durable power of attorney for health care.