Virginia Laws on Do Not Resuscitate (DNR) Orders

If you haven't thought about your final wishes, you should. You never know when your time will be up because not everyone lives into their 80s. While the timing of death is unpredictable, you may not realize that you can control at least one aspect of it: whether you want EMS, ER or other medical facility personnel to attempt to resuscitate you if you go into cardiac or respiratory arrest.

Anyone in Virginia can obtain a Durable Do Not Resuscitate Order (DDNR) from their physician. If you are mentally or physically unable to provide informed consent for a DDNR, your legal representative can obtain one for you. This is where a living will or advanced directive is important because your family will know your wishes. You should clearly define your wishes to your family members, but know that they can revoke a DDNR any time if you are unable to make your own decisions. Your DDNR will never expire and will stay in effect until you or your legal representative revokes it. A DDNR is different from a living will or advanced directive. A DDNR deals only with cardiopulmonary arrest and it's the only legal document EMS can honor. If you have recently moved to Virginia, you must obtain a Virginia DDNR as EMS personnel cannot honor out-of-state orders.

So what, exactly, does having a DDNR mean? It means that if your heart stops or you stop breathing, no medical personnel will attempt to resuscitate you. They will not start CPR, provide artificial respirations, insert advanced airway devices (breathing tubes), start an IV, defibrillate (shock), or administer medication. Medical personnel will attempt to open your airway by adjusting your head and neck. If you are not breathing, no further measures will be taken. Depending on their patient care protocols, they may attach EKG monitoring stickers or defibrillation patches to confirm that your heart has stopped. Having a DDNR does not mean any kind of treatment will be withheld if you need medical care. You will always receive all the appropriate medical care up until you go into cardiac arrest. A DDNR means "do not resuscitate," it does not mean "do not treat"!

Once you decide that you want a DDNR, you need to discuss your decision with your doctor. Physicians have the forms and must sign them to make them valid. You do not need to be elderly or have a terminal illness in order to request a DDNR. Parents or legal guardians can obtain them for their children through the child's pediatrician if appropriate.

You will be given a yellow piece of paper. This is your DDNR. After you have your DDNR, place it somewhere that will be easy to get to in an emergency. It needs to stay in your house but it should accompany you to the ER or an ambulatory surgery facility if you go. Do not put it in a safe, a safe deposit box or give it to a family member to keep for you. If you live alone, place it on your refrigerator door or your bedroom door (or wherever EMS personnel could readily see it). Anyone who lives with you or could visit you should know where you keep the form in case it's needed. Without that yellow piece of paper--and it must be the original because photocopies cannot be honored--Virginia EMS personnel are legally required to initiate all resuscitative measures. Your friends' or family's word is not enough. EMS cannot honor an advanced directive or living will.

What about if you're away from home? How will people know you do not want to be resuscitated? You can purchase DNR bracelets or necklaces through either of the two approved vendors, Oneida Nameplate Company or Appomattox Drug Store. You will need to supply the vendor with a copy of your DDNR in order to buy the jewelry. If you will be traveling, check with your destination's Office of EMS regarding that state's DNR laws because every state is different.

No one wants to think about their deaths. Making your wishes known and taking the legal steps to ensure that they're honored is the responsible thing to do. Obtaining a DDNR is a critical step toward dying on your own terms.