Guide for Patients, Families and Caregivers
The goal of the Thunder Bay Regional Health Sciences Centre Health Care Team
is to provide the best possible care for each patient. At times, this will include
discussions about end-of-life decision-making. Discussions that you have had
with your loved ones will help guide decisions that are made between you and
the health care team caring for you, so deciding about DNAR and other matters
for yourself, while you are able, can help the team make care decisions.
The following information may also assist you.
What do CPR and DNAR mean?
CPR: Cardiopulmonary Resuscitation refers to the medical procedures used to
restart a patient’s heart and breathing when the patient’s heart
and/or breathing unexpectedly stop. These procedures include vigorous chest
compressions, electric shock to the heart, intravenous medications, insertion
of a tube into the patient’s air passage, and artificial breathing or
ventilation. Although CPR may be effective, it is often unsuccessful and many
patients do not survive.
DNAR: Do Not Attempt Resuscitation is a term used to describe the physician’s
order that is written to stop the automatic response of CPR and other aggressive
efforts at resuscitation upon a patient’s death. Patients in Canada and
many other countries have the legal right to refuse such medical treatments
as CPR. DNAR Orders are part of that right. Once the DNAR order is written on
a patient’s chart, it is reviewed, in light of the patient’s condition,
on a regular basis.
How is a DNAR decision made?
You or your Substitute Decision-Maker can request that you be allowed to die
“naturally”, with no aggressive attempts at resuscitation when you
die. Your physician may also decide that to carry out aggressive attempts at
resuscitation when you die would not offer any benefit. In this case, he or
she will meet with you or your Substitute Decision-Maker to explain the futility
of these measures. Following these discussions, the DNAR order is clearly documented
on your chart to ensure that your wishes are carried out.
How does a substitute Decision-Maker decide for me?
You should decide, while you are able, whom you wish to make decisions for
you if you become unable to do so, by completing a Power of Attorney for Personal
Care. If you have not done this, and you do become unable to make your own decisions,
a Substitute Decision-Maker will be selected according to Ontario law which
determines who can be a Substitute Decision-Maker.
In both of these cases, the Substitute Decision-Maker is obligated to make
decisions based on your wishes. Even if you had never expressed any wishes about
what you wanted at the end of life, your Substitute Decision-Maker must still
base decisions on what they think you would decide if you could. Therefore it
is important when you select a Power of Attorney for Personal Care that you
choose someone whom you can trust to carry out your wishes when you are unable
to decide for yourself.
Can I change my mind?
Once a DNAR order is written on your chart, you or your Substitute Decision-Maker
can withdraw it at any time by telling the physician or nurse caring for you.
This change will be noted on your chart.
What happens if I have a DNAR order and I need surgery?
If you already have a DNAR order on your chart, and you are to undergo a procedure
or surgery, you and your physician will re-evaluate your DNAR order prior to
the procedure. You will be asked to suspend the DNAR order during the time period
of the procedure or surgery. This is because resuscitation is a standard part
of the surgical and anaesthesia process. Your DNAR order will be re-instated
after the procedure is completed.
If I have a DNAR order, does this mean I will not receive other treatments?
NO. DNAR DOES NOT MEAN DO NOT TREAT. Resuscitation happens at the end of life.
All appropriate treatments according to your plan of care will still be performed.
Other treatments will be decided upon with your physician according to medical
necessity and in accordance with your wishes. This is sometimes called “comfort
care” as the health care team’s focus is now on the relief of pain
and suffering and other comfort measures, as well as continuing to care for
your spiritual and emotional comfort.
What happens if I have a DNAR order and am transferred to another hospital
or long term care facility?
The DNAR order will continue until a decision is made to change the order based
on a review of your condition. You or your Substitute Decision-Maker will be
part of that discussion and decision.
Who can I contact for more information or to ask questions?
The physician, nurse, chaplain or social worker caring for you can answer many
of the questions that you have. Information is also available by calling:
Chaplain Service Office: (807) 684-6236
Ethics Team Office: (807) 684-6013
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