A do-not-resuscitate order (DNR), the directive to refuse emergency lifesaving medical treatment for terminally ill patients, can be invaluable for clarifying your wishes and avoiding disputes, but also veer into a murky and contentious area of law.
Patients, or their legally-appointed substitute decision makers, have the right to refuse emergency treatment such as CPR or defibrillation if they feel prolonging their life may also prolong their suffering.
Given the potential for doctor-patient disagreement, these kinds of orders are often included in a power of attorney and patients and their substitutes should be explicit with their doctor if they desire a DNR.
Generally, a doctor must honour a patient’s DNR directive, but can ignore one from the patient’s appointed proxy in certain circumstances. If the doctor has cause to believe the patient would want otherwise, or that the proxy is not properly informed, they can overrule that proxy’s refusal of treatment.
If a DNR isn’t clearly indicated on a patient record, emergency treatment will be administered. If you wish to have a DNR order, make sure it appears on your record or that your appointed health care proxy is aware.
If a previously unresponsive patient becomes, in the doctor’s opinion, responsive again during emergency treatment, the patient’s wishes override all others. They can refuse further treatment even in that moment.
Another contentious issue revolves around doctor-imposed DNRs.
Doctors weigh the issue of “futile care,” or providing treatment that offers no reasonable hope of recovery and potentially extends the patient’s suffering with no greater benefit.
In 1995, the Canadian Medical Association and others released a joint policy paper reading, in part, “there is no obligation to offer a person futile or non-beneficial treatment.”
Given that, cases have emerged where doctors have imposed a DNR directive on a patient, despite the family’s wishes.
In 2008, doctors at a Toronto hospital imposed a DNR order on a seriously ill patient who later died after a cardiac arrest. His daughter requested emergency treatment, but the doctors judged there to be no benefit. In 2014, Ontario’s Capacity and Consent Office ruled the decision illegal and said provincial law required the doctors to obtain the daughter’s consent to withhold potential lifesaving treatment.
So while doctors can hold a great deal of power over any DNR directives, you can reduce the risk of any argument by clearly stating your wishes in writing and to your family or health care proxy.
The Canadian Medical Association’s joint statement on resolving ethical conflicts between patients and providers: https://www.cma.ca/Assets/assets-library/document/en/PD99-03.pdf