Apparently even health care providers don’t understand all the different end-of-life forms that might accompany a patient into the hospital.
I watched a parody video (to Green Day’s “Good Riddance”) on YouTube that seeks to educate and eliminate the misunderstandings.
These end-of-life forms, also known as advance directives or health care directives, are similar but differ slightly in scope and usage.
Certainly physicians and nurses should know the difference (and in my experience, most of them do), but it’s equally helpful for patients and family members to understand them so “medical mistakes” can be avoided.
I think Nolo, the online legal website, does a good job explaining the differences and what is needed to make each document legal in different states (some states require witnesses and/or notarization).
In a nutshell, the most common end-of-life forms are:
Anyone of any age can and should have a Living Will. It provides two things: the name of your Durable Power of Attorney (DPOA) for Health Care (different from a financial Power of Attorney) and some broad guidelines as to the level of care you would want in certain situations. Such as “I don’t want life-support treatment if there is no hope for recovery.”
Your DPOA, usually a family member or close friend, is guided by your wishes and makes the necessary medical decisions for you.
A copy of your living will should be in your medical chart so that if you are unexpectedly hospitalized, your DPOA can be contacted.
DNR stands for Do Not Resuscitate.
DNR means do not perform CPR. But it does NOT mean do not treat.
CPR is not effective on patients who are very ill and/or very old. Most often it results in broken ribs, internal damage and a stay in the ICU hooked up to lots of tubes and beepy machines. This is a lousy way to die.
A DNR order can be put in a chart after a patient is hospitalized.
You can also get a DNR order for out of the hospital. I recently asked my mother, who is 85 years old and lives independently, what she would want if she suddenly collapsed with no breathing and no pulse and her neighbors called 911? Would she want the medics to perform CPR knowing that success was very small to none?
She said no. I told her to speak with her primary care physician and have him sign a DNR order that he could put in her medical records, and she could keep a copy at home. I also told her it would only be helpful if the medics could see it as soon as they entered her condo. Many people tape them to the front of the refrigerator or a kitchen cabinet. You can also get a bracelet or necklace that says DNR.
Honestly, though, sometimes the medics ignore these DNRs and you end up in the hospital anyway. Nothing’s perfect.
POLST stands for Physician’s Orders for Life-Sustaining Treatment
POLST forms are required by most nursing homes, adult family homes and assisted living facilities.
The form includes the DNR order, but also has another section where you (or your DPOA) can indicate the level of care want provided. The form explains each level, but basically your choices are:
- Do everything
- Do a limited amount of stuff
- Provide “comfort care” only (i.e. hospice)
POLST forms are usually updated yearly, but can also be changed anytime if your health status or wishes change.
I write a lot about end-of-life issues because I think they are so important, both for the patient and family members.
Related post: Goodbye, Dad
Life is 100% fatal, and although we shouldn’t dwell on our mortality, we should feel comfortable talking about our wishes with those who matter to us, and those who might need to make the medical decisions.