The Meaning of DNR

The treatment of DNR orders shifts from a patient’s limited refusal of resuscitation to a disputed proxy for evacuation priority.

increasingBearing stren­gth in each eventdecreasing

A Specific Medical Choice

A Specific Medical Choice Refusing Resuscitation A DNR order ordinarily means that clinicians should not attempt resuscitation after a patient’s heart or breathing stops. It does not by itself authorize withholding other care or rescue. Personal Autonomy Patients or their proxies use the order to express a limited preference. Its meaning depends on informed consent, not assumptions about a person’s worth or willingness to live.

DNR Patients Ranked Last

DNR Patients Ranked Last An Evacuation Rule Memorial physicians decided that patients with DNR orders would be evacuated after others. Some believed those patients had less to lose or would not want extraordinary rescue. A Category Error The rule treated an order about resuscitation as evidence about survival prospects and rescue preferences. Neither conclusion necessarily followed from the order itself.

Families Challenge the Meaning

Families Challenge the Meaning Orders Reconsidered Angela McManus asked to rescind Wilda’s DNR order when she learned it might keep her mother from evacuation. Another patient’s daughter similarly demanded that her mother be rescued. Consent Reappears The families had approved limits on resuscitation, not abandonment. Their interventions exposed how rapidly an emergency rule could override the intentions behind an advance decision.

A Survivor’s Warning

A Survivor’s Warning DNR Is Not Do Not Rescue A patient was moved after her daughter clarified that the DNR order should not prevent evacuation. The episode showed that DNR status could be changed when circumstances and wishes were reconsidered. Reassessment Matters The patient’s rescue depended on communication and the willingness of staff to question the category. Triage decisions required active reassessment, not a permanent label.

A Broader Lesson

A Broader Lesson Orders Are Not Prognoses Later recommendations warned that DNR status is not a reliable measure of survival or a suitable stand-alone triage criterion. It reflects planning and preference more than medical prediction. Trust at Stake Using DNR orders as a proxy for who deserves rescue risks undermining patient trust. The distinction became a lasting lesson in disaster ethics.

Before Katrina

August 30, 2005

August 31, 2005

September 1, 2005

After Katrina