A Guide To Advance Medical Directives

Some general information about advance directives, including do not resuscitate orders.

Most states have three documents that help ensure that even if patients can’t speak for themselves, they will get only the care they desire when gravely ill. They are: A living will, a healthcare proxy and a do-not-resuscitate order. While the first two are legal documents that are administered according to a state’s laws, the third is a medical directive almost like a prescription order that is filed with your medical chart in your doctor’s office, or at your local hospital.

All three of these documents should be thoroughly discussed and understood by your doctor, your family, and your lawyer. Particularly close attention should be paid to the appointment of a healthcare proxy, since this person will make decisions for you if you become unable to do so.

Living Wills

Though the name varies by state, this document, also known as a declaration, instruction directive, or wishes for terminal illness, outlines the types of treatment you would like or would not like in the event that you have been given a terminal diagnosis or are in a terminally unconscious state. Before the document can become active, most states require that two doctors record a terminal diagnosis on your medical records. The living will will help your doctors and nurses in administering only the types of treatments you designate, even when you are no longer able to communicate with them. The standard forms will give you a starting point, but you may add as many details about your care as you like.

Appointment Of A Healthcare Proxy

Depending on the state, this document may be called an appointment of a healthcare proxy, agent, or representative, or a durable power of attorney. This document provides that your wishes will be followed by a person who will make medical decisions for you if you are unable to make them your self. In most states, a healthcare proxy can act for you at any time that you become unable to communicate for yourself. Unlike a living will, you need not necessarily be diagnosed with a terminal condition.

Do-Not-Resuscitate Order

If your heart or breathing stops, medical workers will always attempt some form of cardiopulmonary resuscitation, or CPR, to revive you. Some people, however, particularly those in the final stages of cancer or other terminal illnesses, may not benefit from CPR, and can chose to forego its use. In this case, the patient, together with his or her doctor, can decide if CPR will be used or not by filling out a Do-Not-Resuscitate Order, or DNR. The DNR is placed directly into the patient’s medical file or chart so that medical staff will be on notice not to attempt CPR. The DNR should be filed with any doctor or care institution that you anticipate using, as it is not transferable between institutions. You may even want to inquire if you can file one with your local Emergency Medical Service.

Reprinted from “A Guide to Advance Directives,” by Ann Villet-Lagomarsino. Educational Broadcasting Corporation/Public Affairs Television, Inc. Reprinted with permission.

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