Posted on May 06, 2019 in Elder Law
All adults should have an advance directive. An advance directive, however, is not a medical order; some may want to have medical orders to provide direction in the event of certain medical events.
What is a DNR?
A DNR order is a “Do Not Resuscitate” order. It orders healthcare professionals not to administer cardiopulmonary resuscitation (CPR) if you are found unresponsive. It only addresses CPR.
If you have a DNR order, you are not telling your healthcare professionals to ignore curative treatment. It is not a “Do Not Treat” order. For instance, your DNR order is not telling doctors to hold back antibiotics, dialysis, transfusions or other life-saving treatments. Those treatments may be beneficial and able to help you stay alive for a longer period of time.
CPR has been proven to have a very low success rate in those who are near the end of life or are experiencing complex medical issues and/or frailty. You may only want to express your wishes about CPR and give orders for what is to be done if you are found without a heartbeat.
What is an Advance Directive?
The advance directive informs healthcare professionals about your treatment preferences, or what you may want if you are in a coma or have a terminal diagnosis and cannot communicate. It also tells them who is allowed to make your healthcare decisions if you are unable (or unwilling to do so). When you can’t speak for yourself, your healthcare team will review your advance directive and talk to your surrogate decision-maker to make healthcare decisions.
Unlike a DNR order, the advance directive is a statement of your treatment preferences. Medical professionals do not have to follow your advance directive; they can ask your surrogate decision-maker to make healthcare decisions. Your surrogate decision-maker may or may not choose what you have written in your advance directive.
Which one do you need?
Just about every adult needs an advance directive for healthcare. This is one of the crucial documents that makes up advance care planning.
Although everyone should have an advance directive, only some people should consider a DNR order. You may want to have a DNR order if you:
• have specific wishes about your end-of-life care,
• are ready for a natural death,
• have a terminal or critical illness, or
• are at significant risk for cardiac or respiratory arrest.
The DNR order does not replace advance directives. The documents work together.
What about a POLST? Physician Orders for Life Sustaining Treatment (POLST) is similar to a DNR order in that it is a medical order that directs healthcare professionals if you cannot speak for yourself. Unlike a DNR order, the POLST addresses more than just CPR. A POLST form gives medical orders and tells medical providers what treatments you want if you are not able to communicate. It tells them what to do regarding CPR, hospitalization, intubation, mechanical ventilation, antibiotic treatment, and artificial nutrition/hydration.
Many patients who could benefit from a DNR could also benefit from a POLST. To learn more about the POLST and DNR orders, talk to your primary care physician.
Free Advance Directives for each state
National POLST Paradigm
Miles Patrick Hurley is a Certified Elder Law attorney in Atlanta, Georgia, serving the legal needs of the elderly population on issues related to aging, including retaining independence, quality of life and financial security. Mr. Hurley is one of only twelve attorneys in the state of Georgia to receive the Elder Law Attorney Certification (CELA), and one of less than 500 nationwide. https://hurleyeclaw.com