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An order of DNR, or Do Not Resuscitate, changes the way some healthcare workers care for patients and can result lowering the priority of care relative to non-DNR patients. In simple terms, many individuals intend a DNR order to pertain only the the last moments of life when the progression of illness reaches a point where the heart stops beating or respirations cease.  Many have no intention of agreeing to reduced care in any way prior to the point at which their heart stops. However, imagine several patients  having acute medical problems in the middle of the night when there is limited medical coverage. At 2 AM there is typically one (or two) residents covering an entire medical unit of patients. If, say, three patients have become acutely ill, someone must be seen first and the young doctor will have to prioritize who he sees first. Is there any doubt that it is likely that the doctor knowing one of the three  patients has DNR status will see that patient last among the others? The reality is that this will occur even if the DNR status patient would benefit most by being seen first. But the DNR status patient will almost certainly not get a level playing field evaluation because the default priority for this patient will be last among the others.  Who can blame the doctor, who does not know the patient’s problems well (he is not the patient’s doctor, but is doing his best covering for others), and has many pressing things to do and barely enough time to do them. Similarly, imagine the case where  there is one ICU bed available and three candidates for that bed.  If one individual is DNR status, does any one believe that the DNR status patient will  be transferred to the one ICU bed ahead of the others, even if, strictly on medical criteria, he would benefit most from an ICU stay?  Caring for many sick individuals when resources are limited limited, dictates decision making which may differ in reality from the theory of evaluating all problems on their merit, regardless of DNR status. It just does not not happen that  way in today’s hospitals . Knowing this, do you really want to agree to a DNR status if you are intent on effectively competing for treatment resources until such time, and not before, your DNR instructions are implemented? Too often, DNR status begins to resemble a palliative care option, which is not at all what was  intended.

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