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If you have ever had a loved-one in the hospital, you've heard the phrase "pull the plug." This is a phrase that generally brings up scary feelings, uncertainty, and fear that the doctors will let your family member die after they hear the next beep (on those scary looking medical machines). A family member will always be the first to say "well it depends on if they have a DNR!" This is both true AND false. Lets discuss...

But before we do... please remember that this information is not legal or medical advice. You should always consult with a qualified attorney or physician in your State before drafting legal documents and (or) making any medical decisions. I have supplied the following information below ONLY as an educational and conversational guide.

So what is a DNR?

Most people have heard the acronym "DNR" at least once in their life. This is short for Do Not Resuscitate. In Texas, the term refers to a type of Medical Directive that will tell health care providers how much life-saving treatment to provide. The State now recognizes two types of DNR's, an (1) Out-of-Hospital Do-Not-Resuscitate Order; and a (2) Health-Care Facility Do-Not-Resuscitate Order (aka In-Hospital DNR).

However, many people do not realize a DNR only covers circumstances that involve your ability to breathe and your heart's ability to get blood and oxygen to the rest of the body. Put simply (but in no way medically sufficient), what happens when you need CPR to save your life?

What does a DNR cover....exactly?It depends on what type of DNR has been ordered. In general, if you have a DNR; you are telling health care providers not to use (or continue) any resuscitation measures that involve:

Cardiopulmonary Resuscitation (CPR)- Pushing down on the middle your chest when your heart has stopped beating to help beat the heart, and breathing into the lungs through your mouth to fill your lungs with air if you have stopped breathing and your heart has stopped beating.

Transcutaneous Cardiac Pacing - Putting pads on the outside of your chest so an electrical impulse can be sent to your heart to try to regulate certain irregular beats that could be dangerous to your life; or

Defibrillation - Electric shocks that are put through your chest to try to start your heart beating again when it has stopped, or

Advanced Airway Management - Putting a tube into your mouth (to breathe for you) if you stop breathing or are unable to breathe well on your own; or

Artificial Ventilation - Fitting a bag (and a mask) over your mouth and nose to push air into the lungs if you are unable to breath on your own or have stopped breathing.

These are fancy medical terms, but the big takeaway should be that a DNR is limited in the circumstances that would prevent doctors, nurses, paramedics etc. from giving life-saving treatment in a time of need.

When does a D.N.R apply?If you have a Out-of-Hospital DNR, then it apply's to:

  • Long-Term Care Facilities;

  • In-Patient Hospice Facilities;

  • Private Homes;

  • Hospital Outpatient or Emergency Departments (IE. emergency rooms);

  • Physician's Offices, and

  • Vehicles during Transport (IE. ambulances).

If a In-Hospital DNR has been ordered, then it only apply's to:

  • Hospitals; and

  • Health Care Facilities.

Who can order a DNR?

The person who will be effected by the DNR is always able to create (and revoke) it as long as they have the mental and physical capacity. However, if the patient is unable to make their own decisions; then:

  • Out-of-Hospital DNR's can be ordered by the (1) doctor; (3) legal guardian; and medical power of attorney. If a patient has no legal guardian or medical power of attorney; then a patients family can order the Out-of-Hospital DNR- a spouse, adult children, nearest living relative (in that order).

  • In-Hospital DNR's can be ordered by the doctor. However, the DNR can only prevent CPR. All of the other life-saving methods that we discussed above are still available to medical staff to use to save the patients life (Transcutaneous Cardiac Pacing, Defibrillation, Advanced Airway Management, and Artificial Ventilation).

What does all of this look like (in real life)?

Lets try and simplify all of the jargon and medical terms by looking at some practical scenarios. The In-Hospital DNR is a relatively new addition to state law; and I will be adding a whole blog on it soon. So in the meantime, lets look at the more common Out-of-Hospital DNR for now.

If Uncle X has an Out-of-Hospital DNR, then it means that CPR (and the other methods listed above) will not be provided by medical professionals in most places he would need it (home, ambulance, emergency room, hospice care etc.) Remember, this only includes CPR and the other methods listed above. So if Uncle X hit his head on a ladder and is bleeding in the ambulance, a DNR will not prevent him from receiving emergency medical treatment UNLESS his injuries require CPR etc.

Lets say Uncle X does not have an Out-of-Hospital DNR, and is in the Intensive Care Unit of the Hospital. The doctor says that Uncle X's head injuries have left his brain unable to tell his body to breathe and he will most likely never be able to breathe on his own. At that point, a DNR may be discussed and created by a (1) legal guardian; (2) medical power of attorney; or most often a (3) family member.

In conclusion.

End-of-Life decisions can be unbearable for both the patient and the family. The best tool you can have in these hard times is knowledge. For any other questions regarding DNR's, or any other estate planning needs; please feel free to schedule a free consultation with the Law Office of John Garland.

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