Advance Directives and Do-Not-Resuscitate Orders: What You Need to Know

What is an advance directive?

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions. The law now says that at the time you are admitted to the hospital, the hospital staff must tell you about advance directives.

Advance directives can take many forms. Laws about advance directives vary from state to state. You should be aware of the guidelines of your state laws regarding the scope and technical requirements that apply to advance directives.

A good advance directive describes the kind of treatment you would want to receive for different levels of illness. For example, the directives would describe what kind of care you would want if you have a critical illness, a terminal illness or permanent unconsciousness. Advance directives usually tell your doctor that you don't want certain kinds of treatment when you are this ill. However, they can also say that you want a certain treatment, no matter how ill you are.

Living Wills

Living wills are one type of advance directive. They only come into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in a certain situations. A living will doesn't let you select someone to make decisions for you.

Durable Power of Attorney for Health Care

A durable power of attorney (DPA) for health care is like a living will, but it becomes active any time you are unconscious or unable to make medical decisions. In a DPA, you select a family member or friend who will be your medical decision-maker if you become unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. If you don't have another person you trust to make these decisions for you, the DPA may not be right for you.

Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.

Do-Not-Resuscitate Orders

Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. You can indicate with an advance directive form or by talking with your doctor that you don't want to have cardiopulmonary resuscitation (CPR) if your heat stops or if you stop breathing. In this case, a do-not-resuscitate (DNR) order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.

Most patients who die in a hospital have had a DNR order written for them before they die. Patients who are not likely to benefit from CPR include people who have cancer that has spread, people whose kidneys don't work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization. If you already have one or more of these conditions, you should discuss your wishes about CPR with you doctor, either in the office or when you go to the hospital. It's best to do this early, before you are very sick and are considered unable to make your own decisions.

Should I have an advance directive?

Most advance directives are written by older or seriously ill patients. For example, a patient with terminal cancer might write that she does not want to be put on an artificial respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control of her death. You might want to consider writing an advance directive even if you are still in good health. An accident or serious illness can happen suddenly, and if you already have a singed advance directive, your wishes are more likely to be followed.

How can I write an advance directive?

You can write an advance directive in several ways:

• Use a form provided by your doctor
• Write you wishes down by yourself
• Call your state senator or state representative to get the right form
• Call a lawyer
• Use a computer software package for legal documents

NOTE: Advance directives and living wills are not complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. The orders should be notarized if possible, and a copy should be given to your family and your doctor.

This information provides a general overview on advance directives and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on the subject.

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