Posts Tagged ‘DNR’

Some Terms to Define Advance Directives

Friday, September 25th, 2009

Learn more about advance directives

Learn more about advance directives

The following definitions are used by the American Hospital Association to define terms used in and about advance directives. These terms, which are part of a brochure provided to help patients, families and the hospitals that serve them, presents key resources to enhance educational efforts and to raise awareness around the important issue of advance directives.

Learn more about advance directives, get your questions answered and find more links that talk about this end-of-life planning at the American Hospital Association site, Put It In Writing.

  • Advance Directive: A document in which a person either states choices for medical treatment or designates who should make treatment choices if the person should lose decision-making capacity. The term can also include oral statements by the patient.
  • Artificial Nutrition and Hydration: A method of delivering a chemically-balanced mix of nutrients and fluids when a patient is unable to eat or drink. The patient may be fed through a tube inserted directly into the stomach, a tube put through the nose and throat into the stomach, or an intravenous tube.
  • Cardiopulmonary resuscitation (CPR): A medical procedure, often involving external chest compression, administration of drugs, and electric shock, used to restore the heartbeat at the time of a cardiac arrest.
  • Decision-Making Capacity: The ability to make choices that reflect an understanding and appreciation of the nature and consequences of one’s actions.
  • Declaration: One type of advance directive, commonly referred to as a living will.
  • DNR: Do Not Resuscitate; a medical order to refrain from cardiopulmonary resuscitation if a patient’s heart stops beating.
  • Durable Power of Attorney for Health Care (DPOA): An advance directive in which an individual names someone else (the “agent” or “proxy”) to make health care decisions in the event the individual becomes unable to make them. The DPOA can also include instructions about specific possible choices to be made.
  • Hospice: A program that provides care for the terminally ill in the form of pain relief, counseling, and custodial care, either at home or in a facility.
  • Legal Guardian: A person charged (usually by court appointment) with the power and duty of taking care of and managing the property and rights of another person who is considered incapable of administering his or her own affairs.
  • Life-Sustaining Treatment: A medical intervention administered to a patient that prolongs life and delays death.
  • Palliative Care: Medical interventions intended to alleviate suffering, discomfort, and dysfunction but not to cure (such as pain medication or treatment of an annoying infection).
  • Persistent Vegetative State: As defined by the American Academy of Neurology, “a form of eyes-open permanent unconsciousness in which the patient has periods of wakefulness and physiologic sleep/ wake cycles but at no time is aware of himself or his environment.”
  • Proxy: A person appointed to make decisions for someone else, as in a durable power of attorney for health care (also called a surrogate or agent).
  • Terminal Condition: In most states, a status that is incurable or irreversible and in which death will occur within a short time. There is no precise, universally accepted definition of “a short time,” but in general it is considered to be less than one year.
  • Ventilator: A machine that moves air into the lungs for a patient who is unable to breathe naturally.

Living Wills Could Save Money Nationwide

Thursday, June 25th, 2009
NHDD

NHDD

On April 19 this year, the nation celebrated its first National Healthcare Decisions Day (NHDD). The National Healthcare decisions Day was designed to help Americans understand that making future healthcare decisions includes much more than deciding what care they would or would not want regarding their health. This initiative also advocates “expressing preferences, clarifying values, identifying care preferences and selecting an agent to express healthcare decisions if patients are unable to speak for themselves.”

In other words, this initiative urges Americans to prepare documents that will clarify your intent, especially when you are not able to communicate this directive because you are incapacitated. While most documents that declare a “Do Not Resuscitate” order if you do not wish to be resuscitated or placed upon life support, many individuals now see this alternative as an AND, or “Allow Natural Death.”

Although advance directives cannot reduce medical expenses for all dying patients, some studies indicate that life-sustaining treatments and other forms of end-of-life care can be extraordinarily expensive and an unnecessary strain on healthcare resources. Each year, for instance, Medicare allocates approximately 30 percent of its funds to the five percent of recipients who pass away during that year.

According to an ABC News article:

According to a recent study by the Dana-Farber Cancer Institute, America could reduce medical costs by $75 million a year if more cancer patients discussed living wills with their families or medical professionals before it became too late. Assuming these figures hold true for other groups of Americans, the potential national savings could be far greater.

Nathan Kottkamp, a healthcare attorney and founder of the initiative, boasts about the success of this year’s initiative that took place on April 16. According to new numbers, at least 3,755 people completed advance directive documents while the campaign exposed potentially millions of Americans to the organization’s message.

“[Living wills] save Americans money because we are more efficient,” Kottkamp emphasized. “This is not saving money because we are pulling the plug.” Furthermore, Kottkamp insists that reducing uncertainty in the medical process can “save tons of money by not involving lawyers.”

Government research, however, shows that living wills or DNR directives are not always effective. Roughly three quarters of physicians treating patients with advance directives were unaware they existed, and some doctors prefer to automatically resuscitate their patients to defend themselves from lawsuits. What can you do to make your wishes known?

Visit the NHDD Web site to learn more. This site also includes links to other sites that can help answer your questions. They also carry information on state-specific resources, although not all states are included.

Changing the Language of Death

Monday, April 27th, 2009

With the waxing popularity of hospice care for end-of-lfe support and health care, many hospitals, hospice or palliative care services and nursing homes are changing the language of death. In one specific incident, this language has changed from one of a negative connotation with a harsh reality to that of a positive tone and a natural process.

For years, do not resuscitate, or DNR, has been the designation for not prolonging life when a person’s heart stops beating or breathing stops. A new designation, allow natural death, or AND, is becoming the preferred term among some entities, including several hospitals within Lutheran Health Network.

Proponents of the AND designation say it creates for patients and medical staff a more positive approach. It is about what is allowed to occur as opposed to what is not to be done.

Sister Carole Langhauser, vice president of Mission Integration at St. Joseph Hospital. St. Joseph and Dupont Hospitals stated that this change is more than semantics – it’s a philosophy. After all, not one person escapes death, so why make it a negative experience for the dying and their loved ones?

Langhauser said physicians are embracing AND over DNR. A 2004 Hastings Center Report compared real-life accounts of two families dealing with end-of-life decisions. The family that was offered the option of signing DNR for a loved one in the event of cardiac arrest became upset and agitated. Another family facing the same dilemma but who was given the “allow natural death” option reported a better understanding of the option and the fact their loved one would be appropriately cared for.

If you’ve thought about your own death, how do you feel about the DNR? Would you want to put that onus on someone else if you were incapable of making a decision? Or, would you rather die a natural death in words, with those words imparting a philosophy to your loved ones that death is a natural part of life?

Either way, it’s the same process. The only difference is how it is worded.

Hospice Workers Can Help With Last Wishes

Monday, December 22nd, 2008

Do you want to end your days tied up to medical equipment without a chance to recover? Many have watched as other people have made the decision to “pull the plug” on loved ones after years of medical care and expense. If you do not want to put your loved ones through this trauma, the best thing to do is to work with a hospice to make sure your last wishes are known.

Why do you need to involve a hospice? A report in the November 1998 issue of RN Magazine stated that without the advantages of hospice care, the outcomes of last wishes were highly reduced. In a survey conducted by that magazine of 743 hospital-based RN’s, 26 percent “have seen a physician or other health care provider deliberately disregard an advance directive. 47 percent [of respondents to the survey] have seen the patient’s family do the same…Among those respondents working in critical care – the [Intensive Care Unit or Critical Care Unit] – that number jumps to more than half.”

Unless you are involved in a sudden accidental death, you may die from a terminal disease or from old age. In the two latter cases, hospice care can help to assure that your end-of-life decisions are respected. But, they can help only if you create a DNR, or a “Do Not Resuscitate” document, an advanced directive, a PMDD and/or a Durable Medical Power of Attorney.

Many varieties of DNR orders exist, and some may create conflicts within the family. For instance, you may agree to choose a medical intervention that involved oxygen or medication, but eliminate CPR (Cardio-Pulmonary Resuscitation). If your family members disagree with your wishes or if you believe that some family members might interfere, it is best to seek legal advice from a professional attorney who practices in this law area. An attorney can help reassure you that your last wishes will be honored.

Only a “Durable Medical Power of Attorney” will authorize another person to make decisions in the place of the patient when you are unable to communicate your wishes (due to a coma or other cause). If you still are able to communicate your wishes, you then always retain the authority to make your own decisions. When you create a Durable Power of Attorney specifying who can speak on your behalf, and specify in detail what your wishes actually are, your wishes are more likely to be carried out. This way, family who may have been unaware of your wishes are less likely to interfere.

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital for illness or surgery, the hospital staff will probably talk to you about advance directives.

The PMDD (Protective Medical Decisions Document) is a protective Durable Power of Attorney for Health Care which is available from the International Task Force. It is a document in which you name someone you trust (a family member, close friend or hospice care worker) to make health care decisions for you if you ever become permanently or temporarily unable to make such decisions for yourself.

If you do not create documents that detail your last wishes and a family member calls the EMS when you are at the point of death, the EMS personnel may be legally required to perform CPR even though you are in hospice and “ready” to pass away. Performing CPR on a terminally ill patient may be extremely painful to the patient and emotionally upsetting for the family.

When you make decisions ahead of time by filling out advanced directive forms, a PMDD or DNR forms to clarify your wishes, you have a legal chance to have your last wishes honored. has You can change your forms at any time, simply by making your wishes known or by re-creating those documents. And, by choosing a hospice care worker as a person to help you meet your last wishes, you can avoid using a family member or a friend as a person who must make tough decisions as they honor your requests.