DNR Orders - How do these work legally?

[#1]

Hi all, Can someone who has the knowledge tell me how the DNR/ not for CPR orders work? From my understanding the way palliative care/hospices work is that you cannot be admitted unless you agree to DNR orders, even if thats not your personal wish. I would also like to know if it applies to public hospitals as well?

[thaker]

Hi I can only tell you my experience with such orders. When my hubby was in hospital the DNR order was explained to me by the neurosurgeon but no pressure was put on me to sign one and I did not sign one. My husband was deteriorating fast and there was a high risk of him having a heart attack. He was already in a lot of pain so any intervention should he have had a heart attack would have just made him more miserable. Point is though I was nto forced to sign one. My husband was then moved to a palliative care unit in Wantirna Health and I was not required to sign one for him to be admitted or when he was there. I was asked what we wanted from his stay at palilative care and because his body was already shutting down and based on his own wishes, we chose minimal intervention and even then only to make him comfortable. So, in my experience, no it is not necessary for a DNR to be signed for admission to a palliative care unit in a public hospital. Hope that helps in some way.

[#3]

Thanks for your response. I'm not sure what state your in, but in NSW, They would not accept my father into any of the palliative care facilities unless he agreed to this. Also, when he was admitted into a public hospital for a procedure, I was told that the DNR order was still in effect from the palliative care facility, in fact I wasn't even asked, I was just told that was the case, in NSW apparently palliative care facilities are hooked up with public hospitals. But I would still assume that the order would need to be either checked with the patient/dr upon admission to the public hospital. Very interesting. Can anyone else shed some light upon this?

[thaker]

oops posted twice.

[#5]

Hi all, My name is Felix, I am a current Cancer Council NSW staff member and one of the Cancer Connections website administrators. I would like to let you all know that we are curently seeking professional advice from our legal advisors concerning the legal aspects of DNR orders and will make that information available on the website as soon as it comes to hand. Kind regards,

[#6]

Thanks Felix. I would like this matter clarified.

[#7]

Hi PS,

Thanks for your enquiries regarding DNR orders. I work with Felix at the Cancer Council and we were really sorry to hear about your father's experiences. We have received some advice from our legal advisers about this issue.

Basically, under the law, each person who is considered mentally capable of making a decision is entitled to make their own decision about whether they refuse or continue life-sustaining treatment. A person can also change their mind as long as they are still mentally capable of doing so, which means that even if you have previously signed a DNR order, you can later write a new directive that specifies that you do want to be resuscitated and receive life-sustaining treatment. If you don't write a new directive, though, any DNR order that you have previously signed will still be in effect.

NSW Health has issued guidelines for end-of-life care and decision-making which include the following as a guiding principle:

The right to know and to choose

All persons receiving healthcare have a right to be informed about their condition and their treatment options. They have a right to receive or refuse life-prolonging treatment. Caregivers have an ethical and legal obligation to acknowledge and honour these stated choices and preferences in accordance with these guidelines.

A link to these guidelines is here. Both public and private hospitals are expected to follow these guidelines, but they are not legally bound to do so. If you are asked to sign a DNR order, and you do not wish to do so, you should raise these guidelines with the relevant hospital.

However, when you are dealing with private facilities, they are of course not obliged to treat you and can impose conditions on the acceptance of patients (including that a DNR order be signed - although this would be quite unusual). It may be that the private facility in question raised the DNR issue because they were trying to explain that they do not have the appropriate resources to treat patients who need to be resuscitated, and that if this is the patient's wish, then they may not be the appropriate facility.

I hope this is helpful for you.

Louisa

[Jules2]

My problem with private facilities asking for a dnr to be signed because they dont have the resources to deal with the person if something goes wrong is (am assuming this dnr follows you around wherever you go to different facilites) what then happens if you end up in a facility that does have the appropriate equipment and they could have revived you and simply didnt because there was a dnr from the private facility in place?