DNR Code Status Explained

One of the more difficult tasks in your life is deciding a “DNR code status” for yourself or, worse yet, a loved one.  DNR is short for Do Not Resuscitate which basically means ‘do not attempt to bring me back to life’.  Some people feel very strongly about having peace at the end of life . . . that you pass this life without disturbance.  Others want to live at all cost and even if their heart is “bad”, give them every chance to live. These two philosophical differences represent the two ends of a spectrum.  If you’ve lived a long life, get ill, and decline in health, your passing is expected . . . and to perform CPR (chest compressions or shocks) seems cruel to some as your last moments could be painful. 

In Ohio, the code status is limited to three: Full Code, DNR Comfort Care Arrest, and DNR Comfort Care.

The naming of these three advanced directives is helpful in some ways and confusing in others. DNR Code Status designations vary from state to state or even from county to county so find out what applies specifically in your area.

In Ohio (where my patients are located), what follows below is what applies to you.

We’ll review these code status’ individually and then go over some examples so you can be perfectly clear on the implications.

FULL CODE

Full code is easy to describe. It means you want “everything” that is medically possible done to keep you (or your loved one) alive. . . no matter what. This essentially means that no matter how much suffering is involved while getting care, it is worth it to get better when all is said and done.

When patients are diagnosed with cancer, many undergo chemotherapy that may cause nausea, vomiting, weight loss, hair loss, diarrhea, and more. . . all in order to get rid of the cancer, and recover and lead a happy normal life after the dust settles. If your heart stopped during this time, it would be appropriate to shock (with the paddles and the doctor yells “CLEAR” and then ZAP) the patient in an attempt to re-start the heart and get them past this sick time. 

You get everything that is clinically indicated.

Not everything that is medically possible. Your doctor still has the last say what is medically reasonable. 

DNR Comfort Care Arrest

This DNR code status is the confusing one! DNR Comfort Care Arrest essentially means that the patient is a FULL CODE until they “arrest” (heart stops or they stop breathing) at which point they would be made “comfortable” without shocking the heart or being put on a ventilator. This DNR code status is appropriate for most ‘older people’ or patients with heart or lung disease.

If you are 85 years old and your heart stops, it is because your heart has run its course. No amount of shocking and chest compressions will convince your heart to start again.  Attempts to start your heart will be futile, and your last moments will be painful as electric shocks and other interventions hurt (again, we tolerate the pain of these options with a FULL CODE so that we can live in case the heart stops and its not because it has run its course).

DNR Comfort Care Arrest is appropriate for most older patients because they will get everything clinically available to them, but when their last moment comes (if they “arrest”), they will be be “kept comfortable”.

With a DNR Comfort Care Arrest, you will get:

  • Surgery if needed
  • Antibiotics for all infections indicated
  • Intensive care treatment (ICU, etc.)
  • Chemotherapy for cancers
  • Anything else medically indicated

DNR Comfort Care

This DNR code status designation means that comfort will be the primary concern at all times. Comfort will drive all medical decisions.

DNR Comfort Care does NOT mean you get NO CARE. 

DNR Comfort Care means that the care you receive will be tailored with your comfort and happiness in mind.  It stresses the quality of your life, not the quantity. Three happy pain free days would be better than ten painful stressful days when both result in death in the end.

Hospice patients typically have a DNR Comfort Care code status. 

DNR Comfort Care CardBecause this can be confusing, here are some examples:

  • Urinary tract infection: could be treated because it is uncomfortable to have one
  • Chemotherapy for cancer treatment would not be offered unless there were specifically causing pain (that was best treated in this way).
  • A patient would not be sent to the hospital unless they would be more comfortable there.  Being packed up in an ambulance, put in the cold, sat in an emergency room, then transported to a hospital bed, then IV’s placed in arms, etc. is NOT comfortable. This situation is to be avoided if comfort is a prime directive.
  • Surgery will usually NOT be done.

Sometimes people carry a identification card for caregivers to see. HERE is one provided by the state.

This summary was difficult to put together (I admit), therefore there may be different angles, approaches to discussion, philosophical views, etc. that I left out. The important point is to have a honest conversation with a doctor you trust. Everything else will flow from there . . .

 

Please add your take on this in the comment section below, and I am sure this explanation will improve with more input!!!

 

Cleveland Black Doctor

Cleveland Black Doctor Cleveland Black Doctor

If you are looking for a Cleveland Black doctor or physician, look no further . . . Dr. Gregory L. Hall is the premier choice in Northeast Ohio. As a specialist in Internal Medicine, he sees patients age 18 and up. While many practices make you wait weeks to see the doctor, we’ll see you quickly, most of the time within the week.

African Americans have particularly severe problems with hypertension, strokes, obesity, and heart disease . . . and also have slightly different needs in the clinical care of these disorders.  Having the expertise and cultural competence in the care of African Americans is Dr. Hall’s specialty, and he is currently writing a book on the special needs of this population.

Louis Stokes Jeff Johnson
From Left to right, Jeff Johnson, Louis Stokes, & Greg Hall, MD

Born and raised in Cleveland’s Glenville neighborhood, Dr. Hall is very familiar with the medical resources available in Northeast Ohio and refers to specialists in their field from across the region.

He also understands the issues specific to the African American Community and makes an extra effort to diagnose and treat these conditions before they can cause harm.

Cleveland Black Doctor Dr. Hall’s office is conveniently located at 464 Richmond Road at the corner of Richmond and Highland in Richmond Hts, Ohio.

Trained at the world famous Cleveland Clinic, Dr. Hall provides up-to-date medical care in a family-like environment. Caring and comical, you will feel immediately at home with Dr. Hall and his staff. If you want a Cleveland-born Black doctor who make you feel at ease and takes time with you, look no further.

Most insurances are excepted, and we provide a sliding scale for uninsured patients who qualify.

Call the office of Gregory L. Hall, MD for an appointment, and you can be seen as soon as the next few days.

216 881-5055

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Cleveland African American Physician

Cleveland African American PhysicianIf you are looking for a Cleveland African American Physician, look no further . . . Dr. Gregory L. Hall is the premier choice in Northeast Ohio. As a specialist in Internal Medicine, he sees patients age 18 and up.  We’ll see you quickly, most of the time within the week.

Internal Medicine is a primary care specialty for adults and Dr. Hall sees patients with diabetes, high blood pressure, arthritis, headaches, dementia, and much more. He will be on your side . . . and has a special ability to explain complicated diseases and conditions.

African Americans have particularly severe problems with hypertension, strokes, obesity, and heart disease . . . and also have slightly different needs in the clinical care of these disorders.  Having the expertise and cultural competence in the care of African Americans is Dr. Hall’s specialty, and he is currently writing a book on the special needs of this population.

Born and raised in Cleveland’s Glenville neighborhood, Dr. Hall is very familiar with the medical resources available in Northeast Ohio and refers to specialists in their field from across the region.

Cleveland African American PhysicianHe also understands the issues specific to the African American Community and makes an extra effort to establish trust, and diagnose and treat these conditions before they can cause harm.

Dr. Hall’s sees patients at his office at 464 Richmond Road at the corner of Richmond and Highland Road in Richmond Heights, Ohio.

Trained at the world famous Cleveland Clinic, Dr. Hall provides up-to-date medical care in a family-like environment. Caring and comical, you will feel immediately at home with Dr. Hall and his staff.

Most insurances are excepted, and we provide a sliding scale for uninsured patients who qualify.

Call the office of Gregory L. Hall, MD for an appointment, and we will see you real soon.

216 881-5055

Cleveland African American Physician

 

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