Health Care Decisions: DNR and Other Advance Directives

Tragedy strikes and your senior loved one is in the hospital. You rush to their bedside only to be bombarded with questions you don’t know how to answer, some true life or death questions.

Now – before you need them – is the time to get your answers ready.

When your loved one is admitted to the hospital, he or she will naturally be assessed by a variety of healthcare professionals and asked innumerable questions about their health history and medications. In addition to these questions, you and your senior will be asked if you have made your health care decisions.  Have you?

It is your senior’s right to make health care decisions and direct his or her own healthcare. Your senior also has the right to refuse treatments. If your loved one is unable to express his or her wishes due to the current medical condition, family members will likely be asked to step in. This is why having a conversation about treatment goals is an important thing for you and your senior to do now.

The health care wishes of your senior are very personal and should be shared, especially with family members who may accompany the senior to the hospital, so that they are sure to be followed when the time comes. If you are not available and they can’t answer for themselves, be sure your senior’s advance directives are available in an emergency, perhaps by keeping them handy in the house for emergency personnel and filed with the primary physician.

What is an Advance Directive?

It is a legal document that states your senior’s wishes (or your own, you don’t have to be a senior) for the doctor and healthcare team to follow in the event that your senior is unable to make a decision. They include:

• Living Will – a document that spells out what medical treatment is desired – and, maybe more importantly, not desired – by your senior loved one.
• DNR – Do Not Resuscitate – an order to healthcare personnel, such as physicians, emergency medical personnel, nurses and others, who may need to save your loved one’s life if his heart should stop beating or she stops breathing, including chest percussion’s and artificial breathing.
• Healthcare Power of Attorney – one person is designated to be the agent who directs the healthcare team using the provisions outlined by the senior. This agent should be a person the senior trusts to follow through with his wishes and is aware of all those wishes. An alternate agent can be named in the event that the primary agent is unable to serve.
• Durable Power of Attorney – typically allows a designated caregiver to make both healthcare and financial decisions for a senior loved one.
• Five Wishes – from Aging with Dignity, is a document that spells out what you want your family to know and includes a wide variety of topics
• POLST – Physician Orders for Life Sustaining Treatment
• Declaration for a Natural Death – also known as a living will

By executing these documents, you as a caregiver and all members of the family will know the direction your senior wishes his healthcare treatment to take.

Your senior must be considered competent to sign his or her own advance directives so don’t wait until it is too late to get these important documents completed. To be competent means that the senior understands the illness, treatment plan, can make rational decisions and is able to communicate these wishes.  There should be two witnesses present when these documents are signed and some restrictions about who can or cannot witness are in place. You may wish to have an elder law attorney help or get help from a company such as LegalZoom. You can see why it would be very helpful to do this now before tragedy strikes as there are steps that need to be followed so that the documents are fully legal to prevent a failure to have your senior’s wishes followed.

A health care decision can be revoked or changed at any time if the wishes of the senior change for whatever reason. After a new document is created, all old copies of health care decisions should be destroyed to avoid confusion or error. People who should have copies of your senior loved one’s advance directives include family caregivers, especially the agent, doctor, lawyer, hospital, lawyer and priest/minister (if desired).

It is important to be sure all health care advance directives meet the requirements of the state where you reside as there are some differences state to state.

This is a difficult conversation for many families but is one that is most effective to have before a tragedy strikes. Don’t forget, as a family caregiver, YOU should also have advance directives which include your wishes for who will care for your senior during your illness or absence.