Do Not Resuscitate (DNR)

How Do I Tell People What I Really Want?

This past week the story and controversy surrounding the death of an 87 year-old woman who did not make her end of life wishes known in writing was covered in the news.  The article by Lisa M. Krieger, "CPR Flap Could Have Been Avoided" in the Mercury News discusses an important form which many people do not know about or confuse with an Advanced Health Care Directive.

While a POLST does not insure a peaceful passing, it does help your health agent know what types of decisions you would want should you become unconscious and unable to choose not to accept certain medical procedures. Paramedics and doctors are not required to follow a DNR form in your wallet or language in the standard form used to name an agent for Health Power.

If you are terminally ill or frail elderly, there are three documents that will allow someone you choose to help you in your final hours. Otherwise, the hospital, doctors, paramedics and all other persons will follow standard medical protocol to keep your body functioning.

The Advanced Health Care Directive.

Many people think an Advanced Health Care Directive will be sufficient. The purpose of this document is to name a person who can make health decisions for you when you are unable to do so. This is why the hospital wants one on file when you are admitted. Doctors and medical personnel cannot make this decision for the patient. While important, since the Advanced Health Care Directive is prepared by an attorney not a doctor, paramedics and emergency personnel do not need to follow any particulars included on this form. In addition, in an emergency there is not time for them to read a legal manifesto.


The HIPPA Authorization Release.

As people age or when they are ill, it can become difficult to manage health care matters - from remembering and getting to doctor appointments to asking the doctor pertinent questions. If you have ongoing health issues, are terminally ill, or elderly, you should also consider signing a HIPPA release form to allow your health agent or another designated person to speak with your doctors about your health care needs. This can be given to more than one person and it is used even while you are competent and able to make your own decisions to allow someone else to speak with your doctors. In the event that you need assistance with health care issues, a HIPPA release form is the only way that someone else can discuss your health needs with the medical community.
The Physicians Order for Life Sustaining Treatment or "POLST".

The medical community developed a solution to help people discuss their end of life wishes in detail with their doctor. It is one page, printed on pink paper and signed by your treating physician. I tell my clients to post it on an entry wall or bedroom door so paramedics and others can see it. This allows the paramedics to not perform CPR, should that be your wish.

Otherwise, once CPR is started and a person receives oxygen, the heart can continue even when the brain is no longer working. Once emergency resuscitation is started, only a POLST or a decision by the named Health Care agent can stop normal ICU and emergency life sustaining treatments.

Below you’ll see links to samples of each form and a short word to remember their use. Review your health care directive to determine if the people you named many years ago are still able to serve you. If changes are needed, a simple amendment with your attorney will keep your written wishes up to date. Should you find, as some of my clients do, that those persons named earlier can no longer serve due to death or illness, you may want to consider naming a licensed, professional fiduciary.

URGENT! First Priority - Advanced Health Care Directive. Attorney Document.
Everyone over the age of 18 years of age should have one. This legal document names who will decide for you in case you can no longer make your own health decisions. Best if prepared by attorney with estate planning package, but the State of California offers this free form here. Second Priority - Assistance with Health Care Management
If you are diagnosed with a significant illness or find that you have trouble remembering what to ask your doctor, it may be time to ask a family member; your health agent; or a patient advocate to assist you in getting the medical care you need. Click here to see sample wording.
Third Priority - POLST. Doctor's Orders 
Make your specific medical wishes known by discussing the options with your doctor and putting it in writing. Then post nearby. Especially important if you have been diagnosed with a terminal illness or you are a frail elder. Click here to see a sample.