Advance Medical Directives and D0-Not-Resuscitate Orders
”every human being of adult years and sound mind has a right to determine what shall be done with his own body,” – Judge Benjamin Cardozo
Advance Medical Directives (“AMD”)
An Advance Medical Directive (“AMD”), also known as a “living will”, which may become effective immediately or it may “spring” into action upon the determination of treating physicians. A springing order only becomes effective once physicians have determined that you are incapable of making informed medical decisions regarding your treatment. At any time prior to this determination, you are free to revoke the AMD should your circumstances change. Through this order, you can appoint an Agent to make medical decisions for you if ever you are deemed to be incapable of doing so yourself. You may also grant your Agent with the authority to oversee and make a wide-range of decisions regarding your care and your hospital stay. It is not mandatory that you choose an Agent in an AMD, you may simply state your wishes for treatment and care should you ever become incapacitated. You may also clearly state which life-prolonging medical treatments you would wish to have if ever you entered a permanent vegetative state or were diagnosed with a terminal condition.
You may remember the Terry Schiavo case which riveted the nation in 2005. Whatever your feelings or stance on that extremely sensitive and difficult case, I think that we can all agree that we would not want to end up with our family members fighting each other in court regarding our healthcare and end-of-life decisions. I highly recommend anyone, no matter the age, to consider drafting an Advanced Medical Directive in addition to a Power of Attorney. Many individuals find it helpful to consult an attorney, who is familiar with AMDs, who will explain the many facets involved, draft the document, and have it executed properly. Another consideration for several people is how their faith/religion shapes their decisions regarding the withholding of medical treatment. I would be more than willing to discuss this with you and potentially draft your important beliefs into any AMD. Further, you may wish to speak with an attorney regarding a loved one’s AMD, if you have questions. I am ready to lend a hand and consult you through this process.
Do-Not-Resuscitate (“DNR”)
In Virginia, the only type of treatment which EMS personnel are allowed to withhold is cardiopulmonary resuscitation. Virginia law recognizes two types of Do-Not-Resuscitate Orders (“DNR”). The first type of DNR is the DNR which may be provided to you when you are initially admitted to a health care facility. If requested, this order is generally entered onto a patients chart while they are in the hospital. If you have been recently admitted to the hospital, you may speak with a hospital representative about your wishes while you are in the hospital. Under Virginia law, the DNR which you request in the hospital will not follow you and emergency medical services (“EMS”) personnel may not follow them. This type of DNR should only be considered by those who wish to not be resuscitated it they are admitted to a hospital without a Durable DNR. This type of DNR should also be considered if you are admitted to a hospital in a state in which you do not have a Durable DNR. This DNR may be requested by someone who is authorized to make health decisions for the patient.
The second type of DNR, a Durable DNR, has an indefinite term and is deemed valid until it is revoked. The Durable DNR differs from the above DNR in that it is portable – It should be followed by any facility, program or organization within Virginia. A Durable DNR may only be issued by the patient’s physician, who must use the ‘Durable Do-Not-Resuscitate (DNR) Order’ form provided by the Virginia Board of Health, and is the only DNR which EMS personnel are able to follow in Virginia. If you have determined that you do not want to be resuscitated under any circumstance, you should consider a Durable DNR. Your usual physician should be able create a Durable DNR for you. Further, those who have the authority to make health decisions for others may speak with the patient’s usual physician about creating a Durable DNR order.
It’s important to have an advocate while you are in the hospital.
It is an unfortunate fact that a patient’s wishes regarding end of life decision-making are frequently ignored or overlooked while in the hospital. My own family has experienced the misfortune, as well as countless others, of having a loved one’s Advanced Directive and/or DNR ignored while in the hospital. The express wishes of my family member regarding her treatment were not followed by the treating physician. There are many causes and facets to this problem, too many to cover in this article. It is important to keep in mind that if a patient is resuscitated or given life-prolonging treatment against their wishes, the general rule is that they may not be awarded damages (i.e. sue).
Remember the old adage “the squeaky wheel gets the grease”? It is important that you have an advocate while in the hospital who will inform the treating physician and nurses of your Advance Directive or DNR. As difficult as the conversation may be, you should consider talking to your family members about your end-of-life wishes so that they may know the reasoning behind your wishes. This may strengthen their resolve to push more thoroughly to ensure that your end-of-life decisions are followed.
Ryan C. Young | Advanced Medical Directive | Richmond, Virginia Attorney