LittlePeopleLogo     Advance Directives

Taking care of yourself and your family means making decisions about medical care while your health allows you to do so.

Although death comes to everyone, many of us tend to fear its approach and may avoid confronting the issues surrounding the end of life. Nevertheless, it is important for each person to document his or her wishes in writing prior to serious illness or physical or mental disability. Otherwise, those wishes may not be known and may not be honored. Not having those desires documented can also create an unnecessary burden for loved ones.

What are advance directives?

Advance directives are written instructions in the form of a living will and/or durable power of attorney for health care. Advance directives do not go into effect until the signer loses decision-making capacity.

A living will (health care treatment directive) is a legal document that communicates a person's desires about withholding and/or withdrawing medical treatment in the event that he or she suffers from an incurable and terminal condition. Living wills set forth in advance the treatment choices and instructions to be followed by caregivers if the signer cannot take part in making health care decisions.

A living will:

• may spell out specific measures that the person wishes, or does not wish, to have taken to extend life when he or she is clearly dying

• may specify the use or non-use of breathing machines, feeding tubes, oxygen, and intravenous fluids

• may list specific illnesses or conditions (persistent vegetative state, coma, terminal illness with no hope of recovery or cure, end-stage dementia) under which the provisions of the living will are to go into effect.

A durable power of attorney for health care (DPAHC) designates a family member or friend to follow the person's wishes and to make medical decisions on his or her behalf should the signer lose decision-making capacity. It is more flexible and comprehensive than the living will, and is regarded by some as preferable to it.

Once signed, such documents should be kept in a safe place, but not in a safe deposit box where they may not be accessible when they are needed. It is a good idea to discuss your wishes with your friends, family members, and your physician. Giving these people copies of your living will or DPAHC also is advisable. That way, should you become incapacitated, others will have access to the documents that express your wishes.

Resuscitate versus Do Not Resuscitate (DNR)

If you are in a clinic, hospital, or nursing home, you may be asked to sign a code status sheet. This will indicate to the staff what measures, if any, you want taken should you be found not breathing and without a heartbeat. Code status may be changed at any time.

Cardiopulmonary resuscitation (CPR) was developed in the 1960s as a way to prevent sudden and unexpected death. When administered quickly, it is generally effective for heart attacks, drownings, drug overdoses, and similar acute situations. However, CPR is not generally effective for people with chronic and severe illnesses where death is expected to occur soon.

A full code means that you want everything possible to be done to revive you. This includes administering chest compressions, electrical shocks, and medication (to start your heart) and putting you on a ventilator (a machine to keep you breathing).

When CPR is medically futile, your doctor should explain why. In those cases, a no code order (DNR, for Do Not Resuscitate) may be written. It is important to recognize that a DNR order only pertains to not having CPR and does not limit other types of treatment. A person should receive all indicated medical and nursing care, even when CPR would be of no benefit. A discussion with your doctor about CPR is an excellent opportunity to review your overall medical condition and treatment plan.

If you have any questions or concerns please ask you doctor.