ADVANCE DIRECTIVES

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An advance directive, sometimes called a living will, is an important legal document used to express your wishes about your end of life care.  In an advance directive you document the care you do or do not want, who will make decisions for you if you cannot make them yourself, and how the decisions will be implemented. Most states have established guidelines for advance directives. The Caring Connections web site offers visitors a model advance directive for each state. You can save the advance directive to your computer and fill it in.  A copy of the advance directive can be given to your doctor, family, attorney, and your designated durable power of attorney. The act of completing an advance directive is an excellent opportunity to discuss with your family and doctor exactly what it is that you do or do not wish to have done and who you want to make decisions for you. When you designate a durable power of attorney you give whoever you name the ability to make health care decisions for you should you not be able to make those decisions.   Designating a durable power of attorney is important should family members disagree about your treatment. Advance directives can be changed at any time in writing by letting your health care agent and doctor know.  Destroy all the old advance directives and complete a new copy. Give the new copy to your doctor, family, attorney, and the person you have designated with durable power of attorney. Keep extra copies of your advance directives at hand just in case you have an emergency trip to the hospital. Hospitals in the United States are required to ask patients if they have an advance directive. Take a copy of your advance directive with you to the hospital or ask while you are there for someone to help you complete an advance directive. You may make the decision that you do not want resuscitation. Your doctor will write at the patient or family’s direction a DNR order. DNR stands for “Do Not Resuscitate”. This means if you stop breathing or your heart stops, doctors and nurses will not perform cardiopulmonary resuscitation (CPR) to get your heart beating again and your lungs working. Usually doctors and nurses focus on helping people get well.  When someone’s heart stops or they stop breathing, health professionals will do CPR unless the doctor, at the direction of the patient and family, has written a DNR order. For people at the end of life it may not be appropriate to try to keep restarting the heart, artificially keep the lungs working, or maintaining an airway. There comes a point when we all die. You, your family, and your doctor will need to decide when that time has come. When doctors ask about a DNR order, they are indicating they believe the time has come.  They are changing the focus to treatment that will be less traumatic. You may or may not decide you want a DNR order. This is a decision only you and your family can make. It’s a disturbing fact, but according to a report by the National Hospice and Palliative Care Organization, sometimes advance directives, even when present, are not followed. It’s in your best interest to do more than just hand over your advance directive document; let there be no misunderstanding. Make a point of talking about it with your doctor and with the hospital staff. Yes, death can be hard to talk about; many health care professionals and lay people see it as a failure of modern medicine. But the fact is, it is inevitable for us all. Written by  Linda Miller, RN, MA Edited by Rachael Myers Lowe, cancerpage.com This page was last edited on 04/18/2008