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Yeah, as a former volunteer EMT, I'd like to ask you not to do this. The rules vary by country and by state in the US; e.g. I can tell you that in New Jersey as

Yeah, as a former volunteer EMT, I'd like to ask you not to do this. The rules vary by country and by state in the US; e.g. I can tell you that in New Jersey as of 10 years ago, there was a standard document (DNR order) which needed to be signed by the doctor and the patient or the legal guardian, which needed to be available to the EMS crew. In any case, I haven't heard that anywhere, a tattoo or bracelet or necklace is legally sufficient, although it may be in your jurisdiction. You'd be putting the EMS crew in a very tough spot: believe me, nobody wants to do pointless resuscitations on people who don't want them, but there are usually very specific policies and laws about when an EMS crew can stop or not attempt resuscitation, and if they aren't met, it's really hard for me to see how an ambulance crew can follow your (apparent) wishes. On a more positive note, I don't think that DNR orders make sense for people without advanced disease, or who are not elderly and in poor health. For the healthier people, an out-of-hospital cardiac arrest is more likely to be caused by something like blood loss in an accident or by electric shock, or by relatively fixable arrhythmias and heart disease. I don't see a reason to prevent the emergency crew and the hospital from giving you a chance.

EvanAnderson 10y ago
Would my having the properly signed copy of a DNR on my person at all times (along with some kind of placard to indicate where on my person it is) be sufficient in your opinion?
- yaakov34 10y ago
  My opinion is not valuable, since I don't know the laws in your jurisdiction. Since, in order to have a proper DNR order in your jurisdiction, you probably need to talk to a doctor, you should just ask them what the requirements are. Again, in New Jersey, what you say will be sufficient, and you can even have a DNR bracelet which is accepted without any further documents, but it's not just some bracelet which says "DNR", it is a non-removable hospital-type bracelet of an official design which has the name of the physician on it, if I recall. What I am trying to discourage is people engraving "DNR" on whatever bracelet or necklace they have, or tattooing it on their chest, without consulting a doctor or getting a proper order or anything else. This will generally not be sufficient, although, again, I don't know for your country or state or town specifically. EDIT: Let me just add that for most people, a living will is really what they want when they think of preventing lingering in the ICU. A living will can say, for example, that in case you become unable to function, and your condition will not improve according to your doctors, you do not wish to be placed on a respirator, or have feeding tubes inserted, or to be resuscitated. (Of course you should consult advisers to put this together.) A living will is not the same as a DNR order; it is more general. I think for most people it doesn't hurt to have it. On the other hand, walking around with a DNR order on you, if you are a person without a known great risk for cardiac arrest, is kind of pointless, IMO. You may, after all, become incapacitated in ways that do not involve cardiac arrest (like traumatic head injury or stroke).
- DanBC 10y ago
  A lot of people reduce advance directives / living wills down to DNR or not DNR, but actually that's the least useful bit of an advance directive. Advance directives should ideally cover all the situations in which you lose mental capacity. Who do you trust to make medical decisions on your behalf; who do you trust to take financial decisions on your behalf; do you care what happens to your corpse, and so on.
SeanDav 10y ago
Counterpoint: > " I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital." Of course, the success rate (where success is defined as the patient going on to live a reasonably normal life) of CPR performed in the field might well be much higher than CPR performed in the hospital.
- yaakov34 10y ago
  I actually don't disagree with that, although the statistics will vary depending on the population served by this particular hospital (e.g. hospital near a ski slope which sees a high number of relatively healthy people who collapsed due to an accident or hidden medical issue will probably have better rates). Unfortunately, the "median" resuscitation call, in my own experience, is for something like "77-year-old cancer patient who is unconscious". We get there and see that there is no pulse, we have to go through the motions if there is no DNR order, but everyone knows it's hopeless, since it's not like we can cure cancer while we do chest compressions. Sometimes we can get a pulse back, but we know - although not "officially" - that the patient will be pronounced dead at the hospital within a few hours. Now I will say one thing here - it is often easier for the family to go through this process, since they can feel that "they've done everything till the very end", although from the point of view of medical practice it would be better to have a DNR order; that's really the type of situation that these orders are for. But to reiterate - if you don't actually have disease that you know of, I would personally recommend giving yourself a chance, like that guy with the pneumothorax got. it's up to you, of course. Though I would say that a living will is probably more useful for most relatively healthy people than a DNR order, since you can end up in a situation in which you are unable to function without any resuscitation being involved. I think a lot of the people commenting in this thread are really thinking of these more long-term situations, rather than resuscitation, which is an on-the-spot decision.
  - earcaraxe 10y ago
    Just to clarify he was saying that the guy with the pneumothorax walked out because he didn't need CPR in the first place

EvanAnderson 10y ago

Would my having the properly signed copy of a DNR on my person at all times (along with some kind of placard to indicate where on my person it is) be sufficient in your opinion?

yaakov34 10y ago
My opinion is not valuable, since I don't know the laws in your jurisdiction. Since, in order to have a proper DNR order in your jurisdiction, you probably need to talk to a doctor, you should just ask them what the requirements are. Again, in New Jersey, what you say will be sufficient, and you can even have a DNR bracelet which is accepted without any further documents, but it's not just some bracelet which says "DNR", it is a non-removable hospital-type bracelet of an official design which has the name of the physician on it, if I recall. What I am trying to discourage is people engraving "DNR" on whatever bracelet or necklace they have, or tattooing it on their chest, without consulting a doctor or getting a proper order or anything else. This will generally not be sufficient, although, again, I don't know for your country or state or town specifically. EDIT: Let me just add that for most people, a living will is really what they want when they think of preventing lingering in the ICU. A living will can say, for example, that in case you become unable to function, and your condition will not improve according to your doctors, you do not wish to be placed on a respirator, or have feeding tubes inserted, or to be resuscitated. (Of course you should consult advisers to put this together.) A living will is not the same as a DNR order; it is more general. I think for most people it doesn't hurt to have it. On the other hand, walking around with a DNR order on you, if you are a person without a known great risk for cardiac arrest, is kind of pointless, IMO. You may, after all, become incapacitated in ways that do not involve cardiac arrest (like traumatic head injury or stroke).
DanBC 10y ago
A lot of people reduce advance directives / living wills down to DNR or not DNR, but actually that's the least useful bit of an advance directive. Advance directives should ideally cover all the situations in which you lose mental capacity. Who do you trust to make medical decisions on your behalf; who do you trust to take financial decisions on your behalf; do you care what happens to your corpse, and so on.

SeanDav 10y ago

Counterpoint: > " I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital." Of course, the success rate (where success is defined as the patient going on to live a reasonably normal life) of CPR performed in the field might well be much higher than CPR performed in the hospital.

yaakov34 10y ago
I actually don't disagree with that, although the statistics will vary depending on the population served by this particular hospital (e.g. hospital near a ski slope which sees a high number of relatively healthy people who collapsed due to an accident or hidden medical issue will probably have better rates). Unfortunately, the "median" resuscitation call, in my own experience, is for something like "77-year-old cancer patient who is unconscious". We get there and see that there is no pulse, we have to go through the motions if there is no DNR order, but everyone knows it's hopeless, since it's not like we can cure cancer while we do chest compressions. Sometimes we can get a pulse back, but we know - although not "officially" - that the patient will be pronounced dead at the hospital within a few hours. Now I will say one thing here - it is often easier for the family to go through this process, since they can feel that "they've done everything till the very end", although from the point of view of medical practice it would be better to have a DNR order; that's really the type of situation that these orders are for. But to reiterate - if you don't actually have disease that you know of, I would personally recommend giving yourself a chance, like that guy with the pneumothorax got. it's up to you, of course. Though I would say that a living will is probably more useful for most relatively healthy people than a DNR order, since you can end up in a situation in which you are unable to function without any resuscitation being involved. I think a lot of the people commenting in this thread are really thinking of these more long-term situations, rather than resuscitation, which is an on-the-spot decision.
- earcaraxe 10y ago
  Just to clarify he was saying that the guy with the pneumothorax walked out because he didn't need CPR in the first place