What would happen if you weren’t able to make your own medical decisions due to a bad accident or other health incident that maybe left you unconscious? Although this kind of scenario may be difficult to think about, it’s a good idea to have legal documents in place so that plans are executed in accordance with your wishes.
The two documents you’ll need to focus on to establish how you’ll want or not want care are your living will and a do not resuscitate (DNR order). There tend to be misconceptions when it comes to these documents in terms of when they become effective and how they interact. Even though both documents are advance medical directives, they serve different purposes, so it’s important to understand how each functions.
Anyone at least 18 years old and of “sound mind” (ability to understand what the living will is, what it contains, and what it does) can create a living will. When establishing your living will, it’s important to consider various care options. Do you want care to extend your life no matter what or only in certain circumstances? If you become terminally ill or permanently unconscious and are concerned about prolonged suffering and maintaining life through artificial means like breathing and feeding tubes and dialysis, you can include instructions for when to cease treatment in your living will.
Your living will becomes effective when you cannot physically communicate your wishes due to terminal illness or permanent unconsciousness. In these circumstances, usually two doctors will examine you and agree that you have a terminal condition or illness that is irreversible and will result in death regardless of treatment. Likewise, a permanently unconscious state would be determined if you were permanently unaware of yourself and your surroundings. Your doctor will certify in writing that these conditions are met and your living will shall take effect.
It’s important to note that a living will only affects care that artificially or technologically postpones death, not care that eases pain. Your doctor is required to provide comfort care through oxygen, pain medication, spoon-feeding and other means until your passing.
Your living will remains effective for as long as you live, unless you revoke it, which you can do at any time.
Do not resuscitate (DNR)
While a living will only goes into effect if you can’t communicate your wishes for treatment, a DNR is different. If your heart or breathing stops, a DNR states that medical professionals should not attempt to revive you.
Ohio offers two types of DNR orders: DNR Comfort Care and DNR Comfort Care – Arrest. The difference has to do with when the order goes into effect. As soon as a DNR Comfort Care order is signed, you will not receive any of the treatments listed in the DNR protocol as ‘Will Not,’ including resuscitative medications, CPR, ventilator care, continuous cardiac monitoring or defibrillation. For DNR Comfort Care – Arrest, you will receive all medical care necessary to treat any illness or injury, including intubation, up until the time you experience a cardiac or respiratory arrest. DNRs are most common in very elderly or frail patients for which resuscitation wouldn’t make sense.
A DNR may be completed by a physician, advanced practice registered nurse or a physician assistant with your consent. Individuals with DNR orders can display it with the DNR order form as well as a necklace, bracelet, wallet card or a hospital-type bracelet. All of these items must contain the DNR Comfort Care logo and the patient’s name. A living will may contain an individual’s DNR choices, but will not be in effect until the living will becomes operative.
Ohio recently made revisions to DNR rules to help clarify the order of precedence of a DNR with a living will and health care power of attorney. The living will supersedes the authority of the power of attorney for health care. The DNR also supersedes the power of attorney for health care, unless there has been a substantial change in the individual’s medical condition as assessed by his or her authorized health care provider. When it comes to a conflict between the DNR and a living will, the most recently completed document will supersede the other.
You can revoke your own DNR at any time verbally, by destroying the DNR order form or by permanently removing the DNR identification items.
Generally, healthcare providers and physicians are required by law to follow the directives in your living will. Ohio law and rules require healthcare providers who are unable or unwilling to honor an individual’s DNR to assist in transferring that individual to another healthcare provider or facility that will. If a facility is discharging a patient with a State of Ohio DNR order to another facility, they are required to notify the receiving facility of the DNR status and send a copy of the State of Ohio DNR form or other authorized form of DNR identification with the patient. The facility must also notify the transportation provider of the existence of the patient’s DNR.
The best way to ensure your living will and DNR choices are honored is to inform everyone involved with your care of your preferences. This includes your power of attorney for health care, family members, physicians and any other caregivers. You should have living will and DNR forms/identification up-to-date and available in your house where they can be accessed by others.
For other questions about living wills and DNRs or to ensure your medical preferences are clearly noted in your legal documents, contact me today to set up a time to chat.