Do-not-resuscitate (DNR) orders increase likelihood of ICU death, less overall care


Doctors may mistake a DNR order to mean a patient wants no additional care under any circumstances

March 6, 2018

As a Houston, Texas medical malpractice attorney, patients and family members frequently ask me questions about the legal impact of advance directives.

An advance directive is a written document that summarizes a person’s health care wishes and preferences. I think it is a good idea to have an advance directive because it benefits both healthcare providers and family members in making treatment decisions when a person is incapacitated.

Some people create advance directives that request all measures to be taken to preserve life. For others, their advance directives instruct healthcare providers to “do not resuscitate” (DNR) in the event of conditions like a cardiac arrest, respiratory arrest, or other serious and disabling injuries.

As an initial matter, the Texas Advance Directives Act of 1999 encourages the use of advance directives and sets basic parameters for their legal effect.

While on its face such a statute seems helpful at first glance, many of my clients are shocked to learn that the law allows hospitals and doctors to override an advance directive. In fact, the law goes further, giving hospital committees immunity for ignoring an advance directive, family member wishes, and even a conscious, speaking patient’s desire for continued treatment.

With very little due process, Texas hospital committees can make a decision that further care is medically futile and then end a patient’s continued curative treatment, as well as food and water. In my view, it is not an overstatement to call this the Texas death panel law.

DNR dangers

A recent study published in the peer-reviewed medical journal Critical Care Medicine concluded that patients having a do not resuscitate (DNR) in place almost double their risk of dying in a hospital intensive care unit (ICU).

For all patients in the study group, those with a DNR order in place had a 28-day mortality (death) rate of 33.9%, as opposed to 18.4% for those patients without a DNR order.

The data are even more staggering when separating out the healthiest patients—those with a low probability of death upon admission to the ICU. In this group, patients with a DNR order had a five-time increase in the mortality rate from 3% to 17% when compared to patients without a DNR order.

The authors of the study believe that this significant problem may be because physicians mistake a DNR order for a patient’s desire to not have any end-of-life care. This may lead doctors to be less inclined to provide treatment in life-threatening situations, including things like mechanical ventilation, diagnostic radiology studies, and administration of medications.

We are here to help

If you or a loved one has been seriously injured as a result of medical malpractice, including mishandling a DNR order, call the experienced attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.


Robert Painter is an attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical malpractice and wrongful death lawsuits against hospitals, doctors, surgeons, anesthesiologists, and other healthcare providers. He previously served as editor-in-chief of The Houston Lawyer, the professional journal of the Houston Bar Association, and currently serves on the editorial board of the Texas Bar Journal.

Robert Painter

Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.


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