Why Advance Directives are Important

At nearly every transition in healthcare people are asked if they have advanced directives. Most people don’t have them. A lot of us, put it off because we don’t think we need them “right now”. But putting off the “right now” can end in compounding stress and grief for the people who are most important to you.

What are advanced directives?

Advanced directives are documents that give you a voice when you are unable to speak for yourself. Advanced directive include:

• Living will
• Do not resuscitate
• Medical power of attorney

 

Living Will

A living will is a document that provides directions to the people who will be representing when you are unable. A living will outlines:

• Medical treatments
• Medical procedures
• Nutrition and hydration directions
• Last wishes related to your health.

Directives you could include in your living will are:

• If you want a breathing tube and for how long.
• If you want a feeding tube to provide nourishment when you cannot eat.
• Whether you want dialysis, chemotherapy, or emergency medications.
• Do you want to accept blood transfusions?
• Whether you are a registered organ donor.

 

A living will can also provide a timeline for any medical intervention or withdrawal of treatments. For example, there could be a statement where a patient is willing to have a breathing tube for 5 days. If at 5 days, the patient is not going to be able to breath on their own then it should be removed and the person should be kept comfortable while nature takes its course.

 Do Not Resuscitate

A do not resuscitate order is a part of advance directives that identifies whether a person wants CPR, emergency medications, or a breathing tube. People can choose any combination of these treatments to be used by first responders, hospital staff, or any care staff if a situation occurs where a person’s heart stops or they stop breathing.

Depending on what is chosen on a do not resuscitate order you will hear healthcare people use the acronyms:

DNR- Do Not Resuscitate means:

• No chest compression (CPR)
• No emergency medications
• No breathing tube

 

DNI-Do Not Intubate ONLY means:

• Do not place a breathing tube

 

People can choose any combination of DNR and DNI. Some people want a breathing tube but not CPR or emergency medications. Others are partial DNR and only want emergency medication and a breathing tube, but not chest compressions. Some people choose to be DNI only.

 

There are not any wrong answers to these decisions, it is about what you as an individual person wants.

 

Medical Power of Attorney

The role of a medical power of attorney can be a confusing concept. People often make the mistake in thinking that once they designate someone as their medical power of attorney that, that person now makes medical decisions for the person regardless of their own ability to act on their own behalf. This is not true.

A medical power of attorney is a person who is designated, by you, to make healthcare decisions on your behalf when you are not able to. Depending on the verbiage in your living will or medical power of attorney documents, this designated person may not make decisions for you unless your spouse, partner, child, or other legal representative cannot. It is really important to have the chain of decision making spelled out clearly so that everyone knows their role and are available to represent you the way you want them to. If you don’t, there are laws in your state that will designate a decision maker for you.

Logistics

One of the primary reasons these important documents do not get completed is because people don’t know how to go about getting them done. It is actually really simple. Here are some options:

• Talk to your doctor
• Download from the internet
• Take advantage of the opportunity if you are admitted to a hospital, it is available every time.
• Go to a lawyer that does estate planning

Some of the documents require a notary. However, this does not stop you from filling the documents out. In addition, a form with the information on it unnotarized is better than nothing at all.

Who Knew Procrastination Could Complicate Life So Much?

Life gets difficult and complicated when we have health issues. Talk about what you want with the people who will be making decisions for you. Save yourself and others who are important to you the stress of navigating the healthcare system on your behalf, wondering if they are representing you the way you want them to. Not knowing and having to act on someone else’s behalf can cause long-standing trauma, regret, and resolved grief. Delaying or failing to put these few documents together will most likely result in either healthcare you did not want or omission of healthcare you did want.

 

Holly Carlson MS, RN, CCRN is a freelance writer and owner of HDC Consulting.  Holly is a registered nurse with 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes direct care, organizational leadership, facility management, and organization culture development.