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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Do not resuscitate (DNR) and health care proxy (medical power of attorney): At some time, you or a loved one may become severely ill, with little or no chance of recovery, or your quality of life will be severely affected if you do survive. Although you have rights (listed above), you are responsible for having an advance directive. Without any directive, your family members or others will have to make decisions about your care if you are unable to communicate your wishes. You should be aware of three types of directives that may help you and your family in this situation if you plan ahead. They are as follows:

Living will: This is a statement, in document form, made by you, that dictates your will regarding your medical care if you become incapacitated with a life-threatening illness. The living will or advance directive clearly explains your wishes and whether you want the doctor to withhold certain types of care if your condition worsens.

• You or a family member should always have this document close by.
• You will need to bring it to the hospital whenever you require immediate care or admission.

Medical power of attorney (health care proxy): With this document you appoint someone to make decisions regarding your medical care if you become unable to make decisions yourself. Make sure the person understands your wishes when you give them this power.

Do not resuscitate (DNR): The DNR order dictates which procedures you do not want to have carried out on you should you become gravely ill. The basic DNR deals with the following:

• Cardiac compressions (pressing on your chest to circulate your blood) if your heart stops
• Being placed on a ventilator (having a tube placed in your lungs so a machine can breathe for you) if you stop breathing
• Electricity being applied to your chest to start your heart if it stops
• Generally, if you do not want these efforts performed in the event your heart stops or you stop breathing, it refers to all the measures. Because all three measures are interrelated, it makes little sense to allow one or two to occur, but not all three.

• Some people may benefit from being placed on a ventilator - those with severe isolated lung problems, for example.
• Being placed on a ventilator can and should be separated from the rest of the DNR order in appropriate cases.
• Speak with your doctor about what you mean when you request DNR for yourself or for a loved one.

• Other considerations also apply to the DNR order.
  • For instance, you may want a DNR order in the event your heart stops or you stop breathing, but you may still want antibiotics, blood products, and any other care - including admission to the ICU or CCU - in the hope that these treatments will cure you.
  • In other situations, you or your family might prefer that only comfort measures be taken after you are admitted. The DNR order might extend to withholding antibiotics, blood products, IV solutions, and other agreed-on treatments.
  • In other words, DNR does not mean "do not treat," unless otherwise specified. It has complex meaning and can be tailored to the needs of either you or your loved ones. Again, make sure you know exactly what the order means when you request it.

Many hospitals give a copy of advance directives to you when you are admitted, along with a copy of the patient bill of rights. Ask for both if you don't receive them. Federal law guarantees these rights.

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