Do Not Resuscitate?

Many of us mistakenly believe that if we have gone to the trouble of having our parents complete a living will and have had an attorney prepare an advance directive identifying a health care proxy for them we have covered all the bases. But this is not the case!

Advance Directives and living wills are not accepted by Emergency Medical Services (EMS) as legally valid forms. If a patient has a living will that states that they do not wish to be resuscitated but does not have an appropriately filled out state sponsored form that is co-signed by a physician, the Emergency Medical Technician (EMT) will attempt resuscitation. This is a little known fact to many patients and primary care physicians that can cause patients to be resuscitated even if their family has given instructions not to do so. Although this law is currently being evaluated for a constitutional challenge it is still in place.

A do not resuscitate document is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR does not affect any treatment other than that which would require intubation or CPR. Patients who are DNR can continue to get chemotherapy, antibiotics, dialysis, or any other appropriate treatment.

The DNR documentation is especially complicated since each state has its own specific approved form. The DNR form for residents of the State of Arizona is required to be printed on orange paper or it is not valid.  The Massachusetts form can be obtained from the Department of Emergency Services and can be downloaded from the site: www.mass.gov/Eeohhs2/docs/dph/emergency_services/comfort_care_bracelet.pdf  It provides for a bracelet to be applied to the patient’s wrist.

It is imperative that you contact your state health and human services department to determine what form is approved in your state. The form must be signed by the health care proxy ( sometimes called the health care agent) or a durable power of attorney and cosigned by a physician. It is recommended that the original DNR form be kept in safe place, and that copies be kept in places that will be readily available to EMS personnel

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Are you a good health care agent?

One of the most important jobs you may ever have is to be designated a health care agent or health care proxy for another person, possibly your parent. In this role you will make heath care decisions for them if they cannot make them themselves. One of the best sources I know of for the forms to designate a health care proxy is provided by www.agingwithdignity.org Their forms are approved in more than 40 states.

Aging With Dignity recommends that you do the following things to be a good health care agent/proxy:

1. Know your loved one’s wishes ahead of time. Ask questions when discussing their wishes with them so that you understand what they want.
2. Introduce yourself to the doctors and nurses caring for your loved one. Make sure that they know you and know how to reach you. Make sure that they have a copy of the document naming you as the health care agent/proxy.
3. Ask questions of the doctors and nurses and follow through with them as they are treating your loved one so you know that your loved one’s wishes are being followed.
4. If you run into problems, ask to speak to the social worker, patient representative or chaplain of the hospital or institution your loved one is in. If a doctor or nurse does not want to follow their wishes, contact the ethics committee of the hospital, hospice, or nursing home.
5. Be courteous but be firm. Sometimes doctors or their staff ignore a patient’s wishes if the health care agent/proxy doesn’t push for them.
6. Obtain a HIPPA release form and have your loved one sign it giving you authority to see their medical records. Without it you will be often be denied any information about their condition or health.

Aging With Dignity provides a document called “The Five Wishes” which allows your loved one to specify in detail exactly how they want to be taken care of. It also has a place for them to name their health care proxy/agent. It combines both a living will and health care proxy into one form. Once it is witnessed by two people and signed by the person it becomes a legal document in more than 40 states. Call 1-888-594-7437 or go to the website www.agingwithdignity.org to order the form.

Aging With Dignity

Have your parents told you want kind of care they want at the end of life? What if they can’t communicate with you when the time comes? They need to have a document called a Living will to make their wishes known. This document is also called an advance directive.
Doctors and lawyers have been urging Americans to fill out advance directives for decades! Yet, according to the Wall Street Journal, less than a third of American adults and less than half of nursing home patients have done so. Many people don’t want to face the fact they they may become sick and not able to communicate with their family how they want to be taken care of.

Your parent might say “If I get to that point I don’t care what happens to me.” You might respond,”Maybe you don’t care, but we do!” Without specific instructions, family members may have to decide whether your parents want to be kept alive artificially, what level of disability they are willing to live with and how to let them die if they had no hope of recovery.

If family members aren’t available, Doctors generally can make the decision whether or not to discontinue medical care if future steps are futile. But many refuse to do that, largely for legal reasons. Without other instructions, in most cases, Doctors will attempt to keep a person alive at all costs.

But studies have shown, most people would not want life sustaining care if they were in an irreversible coma. On the other hand, some patients  might want to be kept alive at all costs and some religions require it.

Advance Directives are not just about ending life, however. Aging With Dignity ( www.agingwithdignity.org) is a not for profit organization that has developed a form which covers five different important areas that should be addressed. These include:

The person I want to make health care decisions for me when I can’t make them myself. (health care proxy)
My wish for the kind of medical treatment I want or don’t want.
My wish for how comfortable I want to be.
My wish for how I want people to treat me.
My wish for what I want my loved ones to know.

This form is legal in 40 states. It is not only a Living Will but It also identifies a health care proxy, an equally important advance directive. The health care proxy is a person who is responsible to carry out you wishes and make medical decisions for you if you cannot. This person must be at least 18 years of age and should not be your health care provider or an employee of your health care provider.

You can receive the Five Wishes Form through the Aging With Dignity Website ( www.agingwithdignity.org) or call them at 1-888-594-7437.

Caring Connections, a program offered by the National Hospice and Palliative Care Organization will provide you with directions on the process of end of life planning. It specifically focuses on the naming of a health care proxy to act in your behalf. You can download the forms to name your health care proxy specifically approved in your state at: www.caringinfo.org

Advance directives do not have to be filed officially. They go into effect automatically as soon as they are signed and witnessed; some states may also require notarization. It’s important to give your family members and doctors copies, or at least instructions on how to access them. Some states have electronic registries that store advance directives online. Google Health has started a similar free online service. See www.google.com/intl/en/health/advance-directive.html

And by the way if you haven’t already figured it out, advance directives are not just for your elderly parents. You need to complete them as well! Because in reality, its not just old people who get sick or have accidents.