ADVANCE HEALTHCARE PLANNING
• Do Not Resuscitate( DNR) and Do Not Intubate( DNI) orders
• If a person has no pulse and is not breathing, these orders instruct medical personnel not to revive your heartbeat or breathing, including by cardiopulmonary resuscitation( CPR), electric shocks( defibrillation), intubation( breathing tubes) and cardiopulmonary medications.
• In the United States, most DNR orders include DNI; however these are sometimes separate orders or forms. The exact wording on DNR / DNI varies by state.
• Medical personnel will try to resuscitate someone unless they have evidence that they have chosen to be DNR / DNI. In many cases, they will need to be shown the original medical order.
• This document is a medical order that must be completed with and by a healthcare provider.
• Other medically-ordered advance care directives
• In the United States, these directives have different names depending on the state where you live. Examples include physician orders for life-sustaining treatment( POLST) and medical orders for scope of treatment( MOST).
• These directives often include a section on resuscitation but go beyond that into other medical interventions to offer guidance on care in emergency situations or near the end of life.
• You can choose your preference for level of intervention, from comfort measures only to limited additional interventions to full scope of treatment.
• You can also choose your preferences for use of antibiotics, intravenous fluids and feeding tubes.
• Like the DNR, these directives are completed with and by a healthcare provider. The type of practitioners who can sign these orders varies by state and may include a physician, nurse practitioner and physician assistant.
Helpful information( and busting some common myths) about advance care directives:
• An attorney is not required to complete advance care directives. In the United States, each state offers a few different forms for Healthcare Power of Attorney and Living Will that are considered legal. You can usually find these forms or templates by searching online, through your hospital system or by asking someone on your healthcare team. An attorney is not required but can be helpful in drafting personalized documents. In some states, advance care directives are legal once they have been signed by the patient while some states require witnesses or notarization. DNR / DNI and other medical orders must be completed with, and signed by, a medical provider to be legal.
• Be aware that Living Will for a Natural Death and DNR / DNI orders are different forms and are often used in different circumstances. It is common for people who have completed their Living Will to think that it covers resuscitation. DNR / DNI is typically used in emergency situations, when a person’ s heart and breathing stops. A Living Will acts as a more general guide for healthcare powers of attorney on a person’ s care wishes or may be used when making decisions about using or ceasing medical interventions.
• Seek education on your diagnosis and on medical interventions prior to completing advance care directives. Often, medical interventions, such as resuscitation, look different in real life than how we are mostly familiar with them, which is through media portrayal. Understanding what medical and life-sustaining interventions would look like for you, depending on factors like your age and health status, can help you make decisions around your care. Additionally, your understanding of your diagnosis, symptoms, treatment options and prognosis are also important factors in defining your wishes and making decisions around your care. While not an easy conversation, it can be helpful to speak with your family physician, neurologist or other healthcare providers about these directives.