Advanced Directives

What impact does a DNR order have on other medical care?

When a DNR order is requested and issued, other care continues as before; a DNR order does not suspend all medical care, but only instructs that CPR not be performed in the event of cardiac or respiratory arrest

When does a living will take effect?

When a patient is both: 1) Unable to make or communicate healthcare decisions, and 2) Terminally ill.

When does a medical power of attorney take place?

When a patient is unable to make or communicate healthcare decisions. Unlike the living will, a patient does NOT need to also be terminally ill.

What is a DNR order?

A do-not-resuscitate (DNR) order is an order not to administer CPR in the event of cardiac or respiratory arrest.

What are the two types of advance directives?

1. Living will (also referred to as healthcare directive, healthcare declaration, medical directive, directive to physician) 2. Medical power of attorney (also referred to as healthcare power of attorney, healthcare proxy, appointment of healthcare agent, durable power of attorney for healthcare, special power of attorney for healthcare)

What is a medical power of attorney?

A medical power of attorney, sometimes known as durable power of attorney for health care, is a legal document granting authority to another person to make healthcare decisions for a patient, should the patient lose the ability to make decisions for him- or her- self. If possible, it is best to have both a living will and a medical power of attorney.

How is a DNR order established

A patient may request a DNR order, either directly or through an advance directive; however, a healthcare professional must issue and sign the order, and, depending on the state, the patient may need to meet certain requirements. For example, in Utah, the patient must be at least 18 years old, and must have a terminal illness diagnosed by a physician.

Are advance directives valid during pregnancy?

Advance directives are not valid during pregnancy in some states.

Is a lawyer necessary for the completion of an advance directive?

Although an advance directive is a legal document, a lawyer is not required to complete an advance directive.

What is an advance directive?

An advance directive is a legal document intended to ensure that healthcare providers honor a patient's decisions regarding treatment, even when he or she is no longer able to communicate those decisions.

Do most states have laws which include punishment for MDs who don't honor a patient's wishes?

In most states, laws regarding advance directives do not include provisions for punishing healthcare providers who refuse to honor a patient's wishes. As a result, providers may believe that refusal to honor an advance directive is legally acceptable.

What actions have courts recently begun taking for providers who imposed care that was inconsistent with a patient's wishes?

In recent years, courts have begun to issue rulings of medical battery in cases of providers who have imposed medical treatment inconsistent with a patient's wishes, as documented in the patient's advance directive.

Do providers take legal risk in honoring the requests of an advance directive?

Providers take no legal risk in honoring the requests of an advance directive, given that the directive itself is compliant and consistent with applicable state and federal law.

What is the ethical/legal distinction between withholding and withdrawing treatment?

There is no legal or ethical distinction between withholding and withdrawing treatment, in keeping with a patient's wishes. In other words, from a legal and ethical standpoint, it is acceptable to withhold treatment, in accordance with a patient's request; it is equally acceptable to initiate treatment, then discontinue that treatment when it is no longer beneficial, given that initiating and discontinuing treatment both are consistent with the patient's preferences

If a patient has a living will, why might he/she need a medical power-of-attorney or healthcare proxy?

While the living will documents the patients preferences regarding end-of-life care, the existence of a healthcare proxy allows for more flexible decision-making. The healthcare proxy is able to make decisions based not only on the patient's written instructions (as documented in the living will), but also on: Overall understanding of the patient Discussion with the patient's healthcare provider Real-time analysis of the potential benefits and burdens of treatment Observation and assessment of changes or unanticipated aspects of the patient's condition

When do advance directives take effect?

advance directives take effect only when a patient is no longer able to make or communicate healthcare decisions for him- or her- self. As long as a patient is still able to make and express decisions, the existence (or lack) of an advance directive is irrelevant. Regardless of the contents of any existing advance directive, healthcare providers must honor the direct instructions of a competent patient. Moreover, healthcare facilities must provide equal access to care, treatment, and services, regardless of the presence or lack of an advance directive.