by F. Burgess (RN, BSN)

Created on: June 07, 2008

Signing a DNR order is not a form of passive suicide but rather a living will' of sorts instructing healthcare providers on your wishes to die with dignity.

Refusal of treatments is more like passive suicide because the consequences would most likely lead to death as explained to the patient. Most DNRs are written for terminally ill patients.

I am not a fan of an order for DNR without further instructions. These may include: no lab tests, no IV fluids unless for pain (may cause painful infiltration), no medication unless for comfort, discontinue invasive treatments if there is no possibility for recovery, position for comfort unless too painful, and no vital signs if no action will be taken.

I like the order to spell out the patients wants and desires, otherwise, it may create a dilemma between family members and/or physicians.

In the ICU, I have witnessed a dying patient receive dialysis 3 times a week until the ethics committee spoke with all family members regarding allowing the prolonging of death.

I once had a patient who was dying from AIDS; he was admitted for pain management only. He wrote a letter To Whom It May Concern with instructions to medicate him for pain every hour even though it may hasten his death. He released us from any legal ramifications.

He requested to be medicated even if he appears asleep. His wishes were to die pain-free and we respected his desire to die with dignity. He was not attempting passive suicide because his condition was terminal already.

A "do not resuscitate" order informs healthcare providers the extent you want to go with treatment but stopping short of prolonging death. If I knew that further blood tests, intravenous fluids, and medications would only prolong the imminent demise and even cause unwanted side effects, I would also request a DNR.

Many people do not realize the importance of Advance Directives, which include the living will. The living will lists just what a person wants or does not want during life and death treatments. This makes it easier for families who must decide whether to continue any useless and probably painful treatments.

As a nurse, I have seen patients, who do not request a DNR order at the onset nor possess a living will, go through treatment that is unofficially labeled "experimental" and "practice" for new doctors when death is imminent.

A living will acts as an instruction manual specifying treatments wanted or not. An example would be "no intubation" (not being placed on a respirator) or being

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