Doctors are often encouraged to discuss advance directives with their patients.
But sometimes, when it comes to act on a “Do not resuscitate” (DNR) order, the situation can be far from clear.
In a provocative essay from the Washington Post, emergency physician Boris Veysman discusses a case where he successfully revived a man who, unbeknown to Dr. Veysman, had a DNR order.
Despite the temporary nature of the illness, the family honored the DNR order and instructed the medical team to place the patient on comfort measures.
Can comfort care sometimes mean aggressive medicine however? That type of nuance can only be considered on a case by case basis, which is why Dr. Veysman argues against a DNR:
I refuse to have a DNR or DNI order for myself. Go ahead, doctor and family, give me some comfort meds, then shock me, tube me and line me.
Life is precious and irreplaceable. Even severe incurable illness can often be temporarily fixed, moderated or controlled, and most discomfort can be made tolerable or even pleasant with simple drugs. In chess, to resign is to give up the game with pieces and options remaining. My version of DNR is “Do Not Resign.” Don’t give up on me if I can still think, communicate, create and enjoy life. When taking care of me, take care of yourself as well, to make sure you don’t burn out by the time I need your optimism the most.
Indeed, a DNR order be too heavy-handed for some situations, and can be improved. Dr. Veysman says there are cases where aggressive measures can be temporarily instituted, so that the patient can die in a more comfortable hospice setting, versus the harsher hospital environment.
Idealistic? Perhaps. But given the numerous cases where patients without advance directives die in intensive care settings, it’s still preferable for patients to give some guidance to family members prior to their unforeseen periods of incapacitation.
