DNRs: Fulfilling their original intention?
DNRs, or do-not-resuscitate orders, first came into being in the mid-1970s, when concerns emerged about universal cardiopulmonary resuscitation (CPR) causing more harm than good for some patients. After a conversation between a patient (or their medical proxy) and their doctor, the doctor may sign a DNR order for the patient, which, in its essence, means that if a patient’s heart stops or they cannot breathe on their own, their medical staff will let them die naturally instead of attempting CPR.
There is often a high degree of stigma surrounding this aspect of medical care, in that some people do not believe it is care at all. Like discussions of euthanasia and physician-assisted suicide, DNR orders often cause patients and their families to disagree.
The problems that emerge with a DNR order may result from its associations, some say. According to Betsy McCaughey, former Lieutenant Governor of New York, media commentator, and author of “Do Not Sign A DNR Before You Read This,” patients with DNR orders are treated as “dying, not recovering” and healthcare personnel may even hesitate to place patients with DNR orders in intensive care units. According to her, medical staff see DNR orders can be synonymous with end-of-life care, when, in reality, DNR orders only bar one procedure: CPR.
In a 2017 study published in “The World Journal of Orthopedics,” researchers found that among hip fracture surgery patients, the mortality rate was over two times greater for patients with DNR orders than those without them. In the words of Ferdinando Mirarchi, an emergency room physician and founder of the nonprofit Institute on Healthcare Directives, “the reality [of DNR orders] is less care.”
Patients often may not fully comprehend what they are agreeing to when they sign a DNR order. The desire for many to sign DNR orders stems from fear: fear of a complication that will leave them hooked to machines, bedridden, unconscious, or unable to take care of themselves. While these are valid concerns, a DNR order may not be the best way to go about preventing or dealing with them given the way they may play out in practice. A more effective solution may be to create a living will, a legal document wherein you can specify in you own words what a hospital is and is not permitted to do if you become incapacitated.
DNR orders were created with good intentions. However, their impact may not always be beneficial. Looking at them philosophically, they may violate two of the four founding principles of the doctrine of Utilitarianism. One is consequentialism, which dictates that consequences, rather than motive or intent, are what really counts. And, the maximization principle says that the number of people affected by an action’s consequences matter.
An effective way to combat the unintended consequences of DNR orders is for healthcare personnel and hospitals to better understand what a DNR order implicates and to learn to better respect patients’ preferences.
~ Saathvika Diviti `25
