A common misconception is that in order to be on Hospice, the patient must sign a ‘DNR’ (Do Not Resuscitate) form. This is NOT TRUE. Patients are not required to elect a ‘DNR’ status to be on hospice and can be a ‘Full Code’ if they choose. 

What is a DNR? 

 

A DNR is a legal document signed both by the patient or their representative and a physician which indicates that if the patient’s heart or breathing were to stop, they do not want CPR , intubation, or heroic measures to save their life and they would like to focus on comfort.

 

What happens if someone does not have a DNR, stops breathing, and 911 is called?

When the emergency professionals arrive on scene, they will ask about and scan the environment for the DNR. It is generally on a bright yellow or red piece of paper that is placed in an obvious spot, such as the bedroom door, wall by the bedside, or even the kitchen refrigerator. 

If this form is not noted by the emergency responder, or family denies that pt has one, the emergency personnel will begin life saving measures including high quality CPR, and may also begin airway management such as intubation, or certain medications to stimulate the circulatory system, and the patient will be taken to the nearest hospital to continue the life saving measures. 

 

There are many studies found online which indicate that for people who were already in the hospital and had an event that required CPR, the survival rate is 24-40%. If someone is not in the hospital, and is either at home or elsewhere in the community and they experience an event that requires CPR, that survival rate drops to about 9-12%.

 

Why would a hospice patient elect to have a DNR if it is not required? 

People may choose to sign a DNR form if they do not wish to be resuscitated, or if the risks and complications associated with the resuscitation process itself outweigh the benefits of being resuscitated. When someone is nearing the end of life or is diagnosed with a life-limiting and debilitating disease, they often consider these things. Generally they know they are declining, they may even talk about it. They can feel their body changing. 

Recovery after the life saving measures have been performed is often a long and grueling process both physically and psychologically. Some common risks during the life saving process can include the possibility of very painful, broken ribs or a punctured lung from the compressions, bruising and altered mental status or changes in the brain activity due to lack of oxygen. Long term problems can include changes in mood, memory, or mental status, decline in functional status, depression, and anxiety to name a few. Remember, on top of all of this, they still have the hospice qualifying, life-limiting severe disease.

So what happens when they went through the life saving process, they’re alive, but barely, and now they are in the ICU on a ventilator, having a hard time being weaned off, can’t communicate, will never be the same, and they are laying in the hospital bed, with 3 IV lines and about 6 bags of medications keeping them going, worse off than they were in the first place. If they are lucky enough to survive and make it to hospital discharge, they still have the life-limiting condition and symptoms. 

This is a sad reality that I personally see nearly every day.

When we prolong life, what are we prolonging? That’s the question.

 

If you are a caregiver making this decision, it is not an easy decision. Do not feel like you are giving up on them. Do not feel like you should have done more or could have done something different. You are saving them from even more suffering and you are giving them the peace and comfort that they haven’t been able to experience for a long time. You are focusing on the quality of the days they have left, rather than the quantity. 

 

While it is not a requirement of hospice to sign a DNR and you are free to choose whatever feels right to you, just keep in mind “the question”. Your hospice team will support your wishes either way.