By Steffani F. Terrell
There is lots of confusion surrounding two frequently used advance medical directives: (i) a Directive to Physicians and Family or Surrogates (“Directive to Physicians”) and (ii) a Do-Not-Resuscitate Order (“DNR”). While these documents may seem similar, the circumstances surrounding when each document might be used is vastly different.
Directive to Physicians
We often hear from clients, “I want to make sure that my children do not have to decide whether to ‘pull the plug’ if the time comes.” The document these clients are referring to is called a Directive to Physicians, sometimes called a Living Will or an Advance Directive. This document is aimed to prevent the type of situation where someone is declared brain-dead, but the family cannot agree on whether to keep the person on life-support (or, machines, treatments, and/or medication that sustain life).
A Directive to Physicians allows a person to decide in advance the level of medical intervention they want if they are later unable to communicate their preferences about end-of-life care. This document allows a person to specify what kind of life-sustaining treatment should be administered or withheld if diagnosed with an irreversible or terminal condition. For example, a person can choose whether to have aggressive care (feeding tubes, ventilators, etc.) or to allow technology to be withdrawn and be kept comfortable only.
Do-Not-Resuscitate Order (DNR)
A DNR is a document that directs health care professionals not to initiate or continue certain life-sustaining treatment in the event of respiratory or cardiac arrest, such as cardiopulmonary resuscitation (“CPR”) or defibrillation. Unlike a Directive to Physicians, which is prepared by an attorney, a DNR must be prepared and signed by a patient’s attending physician.
There are two different types of DNRs: (i) In-Hospital and (ii) Out-of-Hospital. An In-Hospital DNR is exactly as it sounds. It is signed while in the hospital, often times before a surgery, to instruct the hospital personnel as to whether a person wants resuscitation procedures to be administered. An Out-of-Hospital DNR is used outside of a hospital setting in places such as a long-term care facility, a private home, a physician’s office, or a vehicle.
It is important to note that if you elect not to sign a DNR, then medical professionals will administer life-sustaining treatment as their standard procedure. However, even with a DNR, if you are able to communicate your wishes, that will supersede the effect of a DNR order.
A Directive to Physicians and DNR should be considered when finalizing your estate planning. Our attorneys can walk you through the appropriate steps to ensure your wishes will be honored when it comes to healthcare decisions and can guide you in discussing and implementing those decisions with your physician.