What You Need to Know About DNRs and POLSTs

As we navigate the complexities of life, it’s crucial to consider our wishes for end-of-life care. Two important documents that come into play in such situations are Do Not Resuscitate orders (DNRs) and Physician Orders for Life-Sustaining Treatment (POLST). Both serve as crucial directives regarding the level of medical intervention however, they differ in scope, application, and legal standing.

Understanding DNRs

A DNR, is a medical directive that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. DNR orders are typically issued by a physician after thorough discussion with the patient or their legal representative.

Pros of DNRs:

1. Respect for Autonomy: DNR orders respect the patient’s autonomy and right to make decisions about their medical care, particularly in situations where the benefits of CPR may be outweighed by the burdens and potential harm.
2. Reduced Suffering: For patients with terminal illnesses or poor prognosis, DNR orders can prevent unnecessary suffering by avoiding CPR attempts that may only prolong the dying process without improving quality of life. With seniors, compressions may fracture ribs causing immediate pain but also impacting quality of life and ability to recover.

Cons of DNRs:

1. Limited Scope: DNR orders only address the issue of CPR and do not provide guidance on other life-sustaining treatments or interventions. This can lead to ambiguity in decision-making during medical emergencies.
2. Potential for Misinterpretation: Misunderstandings or miscommunication regarding the implications of a DNR order can arise, leading to conflicts among healthcare providers, patients, and families during critical situations.

Understanding POLSTs

Physician Orders for Life-Sustaining Treatment (POLST) forms are more comprehensive than DNR orders. POLSTs document specific medical orders regarding various life-sustaining treatments, including CPR, intubation, and artificial nutrition. Unlike DNRs, which are usually signed by a physician, POLST forms require a physician’s signature along with the patient’s or their authorized representative’s signature.

Pros of POLSTs:

1. Comprehensive Directives: POLST forms provide detailed instructions regarding the level of medical intervention desired by the patient, offering clarity to healthcare providers in emergency situations.
2. Portable and Recognized: POLST forms are portable medical orders that travel with the patient across different healthcare settings. They are legally recognized documents that guide medical decision-making by healthcare professionals.

Cons of POLSTs:

1. Potential for Misinterpretation: Similar to DNRs, POLST forms may be subject to misinterpretation or miscommunication, especially if the patient’s wishes are not clearly documented or if there are discrepancies between the form and the patient’s current medical condition.
2. Limited Flexibility: Once completed, POLST forms may lack flexibility in adjusting treatment preferences as the patient’s condition evolves or as their wishes change over time.

Comparing DNRs and POLSTs

While both DNRs and POLSTs serve important roles in end-of-life care planning, they differ in their scope, specificity, and legal standing. DNRs focus solely on CPR directives, providing a basic directive regarding resuscitation preferences. POLSTs offer a more comprehensive approach, detailing specific medical orders for a range of life-sustaining treatments.  While each has its own set of pros and cons, both serve as essential components of advance care planning. To learn more other senior care issues, individuals can reach out to Oasis Senior Advisors (TheDoyles@YourOasisAdvisor.com – 914.356.1901 or 475.619.4123) for guidance and support.