What is an Advanced Directive?

If you are caring for an elderly friend or relative, someone may have talked to you about an advanced directive.  You might ask what does advanced directive mean? Or what is an advanced directive? Advanced directives are aptly named. They direct people to do what you want them to do, in advance. You can have an attorney help draw the documents up for you, or use one of the online services to help.

An advanced directive is there if you are not able to tell people how to care for you. The most common advanced directive we see in our assisted living homes is the DNR.

What Does Advanced Directive Mean?

DNR – Do Not Resuscitate Advanced Directive

The reason it is called an order is because many times a doctor will write it just like a prescription order. With your agreement of course. DNRs are basically written instructions about what to do when someone is close to death. Not something fun to talk about, but good to plan on ahead of time.

The first thing to realize is a DNR is really not a decision about what to do when you are still technically alive. It is meant to tell paramedics, caregivers or other healthcare professionals what to do AFTER you have stopped breathing or your heart has stopped.

It is not a ‘pull the plug’ kind of decision when someone is still breathing and pumping blood.

There are basically two choices a patient can make:

1. Perform CPR and try to resuscitate me (also known as “Full Code”)
2. Do not resuscitate me (“No Code”)

Pretty simple and straightforward. Once a doctor has this conversation with the patient, he writes up the order. You can’t challenge this order as a family member, even if your relative becomes incapacitated or unable to make decisions for themselves.

Of course, if the person has not specified a DNR and becomes unable to make decisions, the person with Healthcare Power of Attorney can make the decision.

And the patient can always change their mind on what they want. Just let the doctor know to update the order.

Once the patient (or POA) makes the DNR decision, it is important to not keep the decision secret. That would kind of defeat the purpose.

‘Advertising’ Your Advanced Directive

There are several ways to ‘display’ the decision so first responders or other people will know what to do:

• Wallet cards
• Bracelets
• A DNR Document

For our assisted living homes, we will post a DNR form above a resident’s bed, especially when it seems like they are near the end. Here is a link to the Arizona form. You can easily google these forms in other states. For Arizona, you don’t have to have the form notarized. It just needs a witness to sign. Rules vary by state.

Other Forms of Advanced Directive

The DNR covers what happens when you are about to pass. Other advanced directives cover what happens when you are still alive but incapacitated. Here are some examples of other ways you can write an advanced directive:

Living Wills

Unlike a regular will, living wills tell people what you want while you are still alive. They are used in case you are incapacitated (stroke, dementia etc.) to let people know what kind of treatment you would like. If you become incapacitated, a family member may not change your wishes, even if they are your medical power of attorney.

Durable Power of Attorney for Health Care

Remember that an advanced directive directs people to do things on your behalf in advance. Wouldn’t it be smart to pick someone you trust to make unforeseen medical decisions for you? If you don’t have anyone you trust, stick with the living will. It may be a good idea to consult with a lawyer in drafting either a living will or power of attorney.

Physician Order for Life-Sustaining Treatment (POLST) Advanced Directive

If you have a terminal illness, your doctor that you trust may fill out a POLST after talking to you. It shows a combination of your wishes and his professional medical opinion. The document follows you around as the system may transfer and refer you around to lots of different specialists and facilities.

An advanced directive is not a fun subject to discuss with your family. Our previous blog post provided some tips and tricks to discuss tough issues.