What does a do not resuscitate order mean and how do DNR forms work in the UK?

A DO not resuscitate order, or a DNR order, is a medical order from a doctor stating that no steps should be taken to restart the patient's heart or restore breathing if the patient experiences cardiac arrest or respiratory arrest.

This may be given if CPR presents further risks to the patient or keeps in line with the patient's wishes.

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What is a Do Not Resuscitate order?

A DNR order means that a doctor is not required to resuscitate a patient if their heart stops and is designed to prevent unnecessary suffering.

Circumstances where resuscitation is not appropriate include:

• when it will not restart the heart or breathing
• when there is no benefit to the patient
• when the benefits are outweighed by the burdens

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Who can decide to invoke a DNR?

The British Medical Association and the Royal College of Nursing say that DNR orders should only be issued after discussions have been held with patients or their family.

Although it may be difficult to have discussions with patients and their relatives about whether to revive or not, doctors accept that this is no reason why discussions should not take place.

The most difficult cases for discussion are usually those involving patients who know they were going to die, are suffering a lot of pain, but who could live for several months.

Is the order ethical?

Although DNRs can be regarded as a form of passive euthanasia, they are not controversial unless they are abused.

Their primary intention is to prevent patients suffering from the bad effects that resuscitation can cause, including broken ribs, other fractures, ruptured spleen, brain damage.

Healthcare providers need to be able to justify the decision.

Although the order implies that patients must be made aware of a DNR decision and given the opportunity to discuss it, it does not give the individual the right to demand treatment.

Are DNR's used in the UK?

DNR orders are used in the UK but there are procedures that must be followed.

However, NHS Trusts must ensure:

• an agreed resuscitation policy that respects patients' rights is in place
• a non-executive director is identified to oversee implementation of policy
• the policy is readily available to patients, families and carers
• the policy is put under audit and regularly monitored