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June 2003

People often worry about being revived when they are terminally ill and dying. Being revived can be painful and unwanted. If you are or become terminally ill, you should know about "Do-Not-Resuscitate" or "DNR" Orders.  A DNR Order is an order from your doctor saying you are terminally ill and do not want to be revived if your heart or breathing stops. It does not mean you would not receive proper medical care. You would still be kept as comfortable and free from pain as possible. 

One way to get a DNR Order is to ask your doctor yourself. If you can't ask because of your illness or condition, other people may be able to ask the doctor for you.  For example, the person you appointed in a Healthcare Power of Attorney can ask for a DNR Order. If you have not appointed anyone to make healthcare decisions for you, close family members may be able to ask.

A DNR Order is sometimes confused with a Living Will.  Many of the words used to describe them are the same. Their purposes, however, are different.  A Living Will is prepared by you. It tells your health care providers you don't want to be kept alive artificially if you become terminally ill. A DNR Order is prepared by your doctor. It tells health care providers not to try to revive you if you are terminally ill and your heart or breathing stops. 

Before last year, DNR Orders were often not followed unless you were in a hospital. For example, suppose you were terminally ill from cancer and were able to be home or with your family. If your breathing or heart stopped because of your condition, para-medics or other emergency medical service providers would generally revive you.    

A law passed in 2002 changed that. Under the new law, if you are terminally ill and not in a hospital, you can ask your doctor to prepare an "Out-of-Hospital" DNR Order. Your doctor will prepare the Order and give you a copy. If para-medics or other emergency personnel know about this Order, they will not revive you. The best way to be sure emergency personnel will know is to buy and wear a special bracelet or necklace. That way, the DNR information will be with you all the time. Para-medics and emergency personnel must act quickly in a life-or-death situation. If you do not have a necklace or bracelet, they may not know soon enough that you do not want to be revived. You should also place the Order in your home or wherever you are staying so it can be plainly seen at all times.

If you change your mind, you can cancel an Out-of-Hospital DNR Order. One way to cancel is to tell your health care provider. This includes your doctor, para-medics or anyone else who can provide health care services. You can also authorize someone else to cancel the Order. If you are wearing a special bracelet or necklace, take it off.

The new laws for Out-of-Hospital DNR Orders should help ensure respect for the wishes of terminally ill Iowans. The Iowa Department of Public Health has prepared guidelines for Out-of-Hospital DNR Orders that should be effective in September 2003. Remember that these changes only help people after they become terminally ill. The best way for Iowans to have their wishes followed is to prepare a Living Will and talk to their families and doctors before they become ill.