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© 2016 - U.S. Legal Forms, Inc USLegal Pamphlet on Do Not Intubate I NTRODUCTION Do Not Intubate (DNI) means that no breathing tube will be placed in the throat in the event of breathing difficulty or respiratory arrest. Neither an endotracheal tube nor an esophageal obturator airway will be inserted to secure the airway or to assist ventilation. Intubation might prevent a heart attack or respiratory arrest. Refusal of intubation does not mean refusal of other techniques of resuscitation. If you do not want mechanical ventilation (breathing), you must discuss intubation because it may be included as part of a DNI order. Even if you have completed a DNR order that does not mean that you have refused to be intubated. DNR applies to patient who experience acute cardiopulmonary arrest, where as DNI applies only to intubation for patients who experience impending pulmonary failure. Patients may not want CPR and have a DNR order, but may benefit from ventilator support and therefore may not wish to have a DNI order. Refusal of intubation does not mean refusal of other techniques of resuscitation. Since intubation is required after successful cardiopulmonary resuscitation (CPR), the presumption in the case of full cardiopulmonary arrest is that the patient agrees to intubation and mechanical ventilation. Patients may not want CPR and have a DNR order, but may benefit from ventilator support and therefore may not wish to have a DNI order. Rather, they may wish to have a limited trial or long-term intubation and mechanical ventilation. A time-limited trial of intubation and mechanical ventilation provides the patient a choice of a trial of therapy where the underlying acute impending pulmonary failure is potentially reversible and the patient does not wish long-term mechanical ventilation. However, the discussion regarding a Do Not Intubate order is in the context of a patient/resident who still has a pulse and/or is breathing. Such a patient who chooses not to be resuscitated may still consent to external defibrillation, Heimlich maneuver, clearing of the airway, etc. If you do not want mechanical ventilation (breathing), you must discuss intubation because it may be included as part of a DNR order. Even if you have completed a DNR order that does not mean that you have refused to be intubated. If you do not want life mechanically sustained, you must discuss your decision about intubation with your doctor. E NFORCING A DNI O RDER The DNI order is generally prominently noted in the patient's medical chart. The patient can change a DNI order at any time, and experts urge that such an order be reviewed regularly. In a DNI situation, a patient is provided comfort care. Without such an order, emergency medical technicians are legally required to perform CPR. It is also essential to keep a DNI Order visible and accessible at all times so that emergency medical personnel, such as EMTs and paramedics, can provide care and transport without intubation. Some families keep the document on the refrigerator door or in a clearly marked folder.