DNR Order: Passive Suicide or Death with Dignity?

Refusal of treatments is more like passive suicide because the consequences would most likely lead to death as explained to the patient. Most DNRs are written for terminally ill patients.

I am not a fan of an order for DNR without further instructions. These may include: no lab tests, no IV fluids unless for pain (may cause painful infiltration), no medication unless for comfort, discontinue invasive treatments if there is no possibility for recovery, position for comfort unless too painful, and no vital signs if no action will be taken.

I like the order to spell out the patients wants and desires, otherwise, it may create a dilemma between family members and/or physicians.

In the ICU, I have witnessed a dying patient receive dialysis 3 times a week until the ethics committee spoke with all family members regarding allowing the prolonging of death.

I once had a patient who was dying from AIDS; he was admitted for pain management only. He wrote a letter To Whom It May Concern with instructions to medicate him for pain every hour even though it may hasten his death. He released us from any legal ramifications.

He requested to be medicated even if he appears asleep. His wishes were to die pain-free and we respected his desire to die with dignity. He was not attempting passive suicide because his condition was terminal already.

A "do not resuscitate" order informs healthcare providers the extent you want to go with treatment but stopping short of prolonging death. If I knew that further blood tests, intravenous fluids, and medications would only prolong the imminent demise and even cause unwanted side effects, I would also request a DNR.

Many people do not realize the importance of Advance Directives, which include the living will. The living will lists just what a person wants or does not want during life and death treatments. This makes it easier for families who must decide whether to continue any useless and probably painful treatments.

As a nurse, I have seen patients, who do not request a DNR order at the onset nor possess a living will, go through treatment that is unofficially labeled "experimental" and "practice" for new doctors when death is imminent.

A living will acts as an instruction manual specifying treatments wanted or not. An example would be "no intubation" (not being placed on a respirator) or being removed from the respirator, when there is no possibility for recovery.

I have added, to my living will, that I do not want IV fluids unless the IV route is used for pain management. The living will allows you to be very specific about the type of treatments wanted or not.

I had the unfortunate task of making my mom a DNR in 1987 when it was discovered that her cancer had spread too many areas and she went into a coma due to contrast dye. She was placed in ICU where all types of drugs were used to maintain a blood pressure.

I knew she was not going to survive so I had a phone conference with my siblings, we decided to let mom die with dignity. Even after making this decision, nurses continued to hang drugs to maintain her blood pressure even though she was unresponsive. I had these discontinued immediately.

If these drugs spill out of the vein due to a bad IV site, they may cause discomfort; if a blood cuff is pumped too high, it may cause discomfort; if we are not to correct any labs, I did not allow blood to be drawn.

I had to act based on my knowledge of what mom would not have wanted. Since she was not to recover, it was pointless to continue invasive treatments. I only asked for comfort care.

Many patients are requesting DNR orders because they have seen or heard of instances where doctors try to play god by attempting any type of treatment and hoping it works.

I have seen things done that I only wished the family would discuss chances of survival before allowing doctors to continue with treatment.

Some family members may feel they have not done enough and do not want to feel guilty regarding care that should have been done.

I have seen patients who are mercifully tortured with medical treatments because no one will advocate for their rights to die with dignity.

I consider multiple painful needle sticks, dressing changes to wound that will not heal before the patient dies but causes great discomfort during care, and unnecessary tube feedings, the types of treatment the doctor should explain the desired outcome.

I remember asking my elderly aunt about a living will before her Alzheimer disease worsened but she could not understand that it was different from a regular will. Unfortunately, she suffered complications related to tube feeding in the stomach. She vomited the formula, aspirated into her lungs, and developed pneumonia at the age of 93. She never recovered.

No, a DNR is not suicide but a desire to die with dignity.