Understanding DNR Orders
Do not resuscitate orders, or DNRs, are requests made to the health care providers not to engage in cardiopulmonary resuscitation (CPR) should the heart of their loved ones stops, or if they stop breathing. This should be specifically requested, otherwise, the
Do not resuscitate orders, or DNRs, are requests made to the health care providers not to engage in cardiopulmonary resuscitation (CPR) should the heart of their loved ones stops, or if they stop breathing. This should be specifically requested, otherwise, the doctors or hospital staff will try to assist any patient in this situation.
When thinking about DNRs, the concept of euthanasia comes to mind. Active euthanasia, which takes place when several actions are taken to end the life of someone suffering due to a terminal illness, is not permitted in Costa Rica since it is found penalized as mercy killing.
Passive euthanasia, on the other hand, comes from stopping certain actions (omission) to resuscitate a person to save his/her life. It is letting the normal cycle of life take its course, without interruptions, nature is simply left to do its job as long as it is the patient’s will.
This passive form of euthanasia is in fact permitted when considering that the right to health, as contemplated by both Costa Rican and international regulations, encompasses both rights and freedoms, and these two include the right of people to control their health and body without interference, such as torture, medical treatments, and non-consensual experiments; therefore, it includes the possibility of denying certain medical treatments.
DNRs are a mild form of passive euthanasia as it only involves withholding minor treatments, but it does not engage on the cessation of extensive medical treatment or surgery.
Moreover, the right to information plays an important role when considering DNRs. The right to information is the patient’s right to information related to the application of medications and medical procedures, which is known as informed consent.
According to local regulations, no one may be subjected to a medical or surgical treatment that involves a serious risk to his/her physical integrity, health, or life, without the patient’s prior consent or that of the person called to give it legally, if the patient is not able to give his/her consent at the time, with the exception of emergency treatments.
Therefore, it is understood that DNRs indeed are permitted and possible in Costa Rica; however, the concept is neither very well known, common, nor even considered by Costa Ricans when thinking about the future and estate planning. Thus, the practice prevails that the physician is obligated to do whatever possible to keep a patient alive.
At this point, clearly when people are aware they can surely refuse certain medical treatment, or that they can choose to delegate that authority to someone else they trust by a power of attorney (which would come into effect if the person is unconscious and therefore incapacitated to refuse medical treatment himself/herself) they would start to consider more and more this option.
If you wish to grant this medical POA, be sure to delegate the authority in someone you trust and resides in the country, and to entrust the preparation of this POA to a legal advisor, so that the document includes all the required information for it to be enforced.
Do not hesitate to contact us should you have any questions or comments. We will be glad to answer your questions and help you with your planning.