Understanding DNR Orders: A Realistic Look at End-of-Life Decisions

Do Not Resuscitate orders or DNRs:  chances are you've heard of this document, but many are unsure exactly what it means.  If you've wondered about DNRs, their implications, and the myths surrounding them, this episode will enlighten you.

We welcome back guest, Nikki Inches, a resident care navigator and social worker at Mannor Law Group, who shares her expansive knowledge on DNRs, helping us differentiate them from healthcare power of attorney or patient advocate designations. Host Bob Mannor and Nikki delve into this realm, exploring what a DNR actually entails and the conditions under which it comes into play. 

Nikki & Bob demystify the actual stipulations of a DNR - it's an order, signed by oneself, witnesses, and a physician, that one does not want chest compressions started if their heart stops beating. But who gets to make this crucial decision and when should this topic be discussed? We venture into these critical aspects, highlighting the importance of having this dialogue, especially in light of dealing with dementia patients. Tune in to our insightful conversation as we take a realistic look at end-of-life decisions and their importance, regardless of age.

Executive Producer: Savannah Meksto
Assistant Producer: Andria Conner

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ABOUT US:
Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.

We also help families dealing with dementia, Alzheimer’s disease, Parkinson’s disease, and other illnesses that cause memory loss. We take a comprehensive, holistic approach, called Life Care Planning. LEARN MORE...

Episode Transcript

Nikki Inches (00:01):
You're listening to Advice from your Advocates, a
show where we provide elder lawadvice to professionals who
work with the elderly and theirfamilies.

Bob Mannor (00:11):
Welcome back to Advice from your Advocates.
Today we have a very good topicthat people really need to know
about, and it is about DNRs.
Do not resuscitate orders.
Okay, and our guest is NikkiInches, one of our resident care
navigators and social workershere at Mannor Law Group.
Welcome, Nikki, Hi.

Nikki Inches (00:30):
Hello.

Bob Mannor (00:33):
So Nikki has a lot of expertise.
She's worked with hospiceorganizations, she's worked a
lot with the DNRs do notresuscitate orders, and so we're
going to get her insight onthis and I think this is going
to be really valuable for peopleto really understand what a DNR
is and what it isn't.
So I'd like to first, if it'sokay with you, talk about what
it isn't, absolutely so.

(00:55):
A lot of people come in andthey're 50 years old, 60 years
old, they're jogging, they ranthe CRIM, they you know, they're
in perfect health and they saywell, don't forget, we need a
DNR.
No, you don't, you.
What you're probably lookingfor is a patient advocate or
healthcare power of attorney.
So in Michigan, what we need isand we'll talk about other

(01:17):
states too but in Michigan youneed a.
Some people call it a patientadvocate, some people call it a
healthcare power of attorney,but it's where you appoint
someone else to be able to makehealthcare decisions, including
end of life decisions, which iswhat kind of the DNR concept is.
But end of life decisions arediscontinued medical treatment

(01:38):
in the event that you can't doit yourself.
So those documents only takeeffect if you can't make the
decision.
Even once you sign those.
You always get to make thedecision yourself.
It only takes effect if twodoctors have certified that
you're not capable or you'reunconscious and you can't make
the decision yourself.
And it usually involves thingslike end of life and respirators

(01:58):
and ventilators and things likethat.
So that's how we handle thatwhen you're healthy and when
you're.
You know we wouldn't want a DNR, which we'll talk about in a
minute.
In other states they usesomething called a living will.
Some people will sign livingwills in Michigan but we they're
not preferred by the law, bythe courts in Michigan, to have
a living will which just statesunder what circumstances you

(02:20):
wouldn't want to receivetreatment, you wouldn't want to
be on a respirator, ventilator,things like that.
And the concept of that is it'senforceable on its face.
They don't have to check withyour spouse, they don't have to
check with your kids, they don'thave to check with your parents
or whoever it is that you loveand trust to help make that
decision for you.
So in Michigan it's a littledifferent.
You've got to appoint somebodyto convey your wishes for you.

(02:43):
In other states you can havethat living will where it, just
on its face, can be enforceable.
So none of those are DNR.
Sometimes people confuse thelanguage a little bit, so now
let's talk about what is a donot resuscitate order, a DNR,
nikki, what is a DNR?

Nikki Inches (03:01):
So a DNR is a paper that you will talk about
with your physician, you willtalk about with your family.
It is an order that is signedby yourself witnesses and your
physician that states that inthe event that your heart stops
beating, that you stop breathing.
You do not want chestcompression started.

Bob Mannor (03:21):
So it's primarily for resuscitation, correct?
Okay, I used to, and I was halfjoking and you corrected me one
time when I said this that ifyou have a DNR, that means that
they won't give you the Heimlichmaneuver if you're choking on a
chicken bone and you correctlycorrected me that said nope, bob
, you're wrong, they will stillgive you the Heimlich maneuver.

Nikki Inches (03:41):
Yes, and that's important to know.
It is important to know becauseit doesn't include those things
leading up to.
They're still going to try andhelp you up to the point that
they would start compressions,but you're saying please don't
start compressions on me Okay.

Bob Mannor (03:55):
So what would be an appropriate?
Well, who makes that decision,I guess is the most important.

Nikki Inches (03:59):
So Ultimately, as long as you're able to, you make
that decision yourself.
Ideally, that is a decisionthat you will make, you will
talk to your physician about,you'll talk to your family about
.
In the event that you are notable to make that decision, it
depends on the circumstances ina nursing home or skilled

(04:21):
nursing facility type situation.
The only other people that cansign that for you are your legal
representative.
So, whether it's yourhealthcare power of attorney, it
is your guardian, somebody likethat.
It cannot be a next-up kin thatdoesn't have that authority.

Bob Mannor (04:36):
Yeah, so it's difficult sometimes.
We often advise or do trainingsfor people that work in nursing
homes and that is the biggestquestion that we ever get what
if they don't have a power ofattorney in place, a healthcare
power of attorney, a patientadvocate?
How do we know whether or notthat we should resuscitate or
not?
You're right.
You either have to have that ora court order.

(04:57):
To the extent, this is reallyinteresting.
Many years ago in Michigan,even a guardian couldn't sign a
DNR.
Now, and for many years, aguardian can sign a DNR.
So if you're a court-appointedguardian, you can sign a DNR, or
if you're appointed by theperson as their patient advocate
or healthcare power of attorney, you can sign a DNR.
That's very important that wehave that option.

(05:19):
Talk to us a little bit moreabout what is the conversation,
under what circumstances thiscan be brought up, or should the
family maybe bring it up?

Nikki Inches (05:29):
Typically, it's brought up as we see our health
declining.
We're watching our family gothrough things.
Maybe they have received aterminal diagnosis and they've
decided that they don't want tocontinue treatment.
At that time, it might beappropriate to say I'm not doing
any more treatment and so Iwant to let things happen

(05:50):
naturally.
Therefore, I want to have theDNR in place, Sometimes as the
healthcare power of attorney orguardian or whatever it may be,
as we're watching, maybe mom isdeclining into her dementia
diagnosis and she's not the sameperson she was and not able to
take care of herself and is notremembering to eat and do those

(06:11):
things.
Are we wanting mom, if her bodydecides it's time to shut down?
Are we wanting to make thatdecision to do CPR and keep her
with us, or are we wanting tomake that decision to let her
body do what it's trying to do?
Those are some of thoseinstances where you'd be looking
into is it time to make thatdecision?

Bob Mannor (06:30):
That's a great way of saying that.
I was going to bring that upabout dementia.
That's a more difficult issuethan if somebody is terminally
ill and they can, verbally, theycan articulate that they don't
want that.
But it's very hard for familieswhen somebody has dementia and
then they've never articulatedthat.
We never have anything inwriting that articulates that,
but it is a conversation thatshould be had.

(06:51):
Is this what we know about mom,what we know about dad?
Would they want this and shouldwe consider a DNR?

Nikki Inches (06:57):
in that case, absolutely.
I think, even if the DNR isn'tsigned, those conversations are
important to have anyway,because we never know when
something might happen.
Having those conversationsabout what are my wishes, so
that we have that person who'sable to help in those situations
.

Bob Mannor (07:14):
Excellent.
Appreciate you, nikki.
This has been a very goodconversation, a very important
conversation for families tohave.
I know it's not easy, but it'simportant that you have that
conversation honestly,regardless of your age.
So I appreciate you coming toAdvice from your Advocates.
Thanks for listening and don'tforget to subscribe to Advice
from your Advocates on any ofthe podcast platforms.

Nikki Inches (07:37):
Thanks for listening.
To learn more, visitmannorlawgroup.
com.