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Info for Families
About Advanced Directives
DNR Form (PDF)
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Advance Directives and Do Not Resuscitate Orders
What is an advance directive?
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, the hospital staff will probably
talk to you about advance directives.
A good advance directive describes the kind of treatment you would want
depending on how sick you are. For example, the directives would describe what
kind of care you want if you have an illness that you are unlikely to recover
from, or if you are permanently unconscious. Advance directives usually tell
your doctor that you don't want certain kinds of treatment. However, they can
also say that you want a certain treatment no matter how ill you are.
Advance directives can take many forms. Laws about advance directives are
different in each state. You should be aware of the laws in your state.
What is a living will?
A living will is one type of advance directive. It only comes into effect
when you are terminally ill. Being terminally ill generally means that you have
less than six months to live. In a living will, you can describe the kind of
treatment you want in certain situations. A living will doesn't let you select
someone to make decisions for you.
What is a durable power of attorney for health care?
A durable power of attorney (DPA) for health care is another kind of advance
directive. A DPA states whom you have chosen to make health care decisions for
you. It becomes active any time you are unconscious or unable to make medical
decisions. A DPA is generally more useful than a living will. But a DPA may not
be a good choice if you don't have another person you trust to make these
decisions for you.
Living wills and DPAs are legal in most states. Even if they aren't
officially recognized by the law in your state, they can still guide your loved
ones and doctor if you are unable to make decisions about your medical care. Ask
your doctor, lawyer or state representative about the law in your state.
What is a do not resuscitate order?
A do not resuscitate (DNR) order is another kind of advance directive. A DNR
is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops
or if you stop breathing. (Unless given other instructions, hospital staff will
try to help all patients whose heart has stopped or who have stopped breathing.)
You can use an advance directive form or tell your doctor that you don't want to
be resuscitated. In this case, a DNR order is put in your medical chart by your
doctor. DNR orders are accepted by doctors and hospitals in all states.
Most patients who die in a hospital have had a DNR order written for them.
Patients who are not likely to benefit from CPR include people who have cancer
that has spread, people whose kidneys don't work well, people who need a lot of
help with daily activities, or people who have severe infections such as
pneumonia that require hospitalization. If you already have one or more of these
conditions, you should discuss your wishes about CPR with your doctor, either in
the doctor's office or when you go to the hospital. It's best to do this early,
before you are very sick and are considered unable to make your own decisions.
Should I have an advance directive?
Most advance directives are written by older or seriously ill people. For
example, someone with terminal cancer might write that she does not want to be
put on a respirator if she stops breathing. This action can reduce her
suffering, increase her peace of mind and increase her control over her death.
However, even if you are in good health, you might want to consider writing an
advance directive. An accident or serious illness can happen suddenly, and if
you already have a signed advance directive, your wishes are more likely to be
How can I write an advance directive?
You can write an advance directive in several ways:
- Use a form provided by your doctor.
- Write your wishes down by yourself.
- Call your health department or state department
on aging to get a form.
- Call a lawyer.
- Use a computer software package for legal documents.
Advance directives and living wills do not have to be complicated legal
documents. They can be short, simple statements about what you want done or not
done if you can't speak for yourself. Remember, anything you write by yourself
or with a computer software package should follow your state laws. You may also
want to have what you have written reviewed by your doctor or a lawyer to make
sure your directives are understood exactly as you intended. When you are
satisfied with your directives, the orders should be notarized if possible, and
copies should be given to your family and your doctor.
Can I change my advance directive?
You may change or cancel your advance directive at any time, as long as you
are considered of sound mind to do so. Being of sound mind means that you are
still able to think rationally and communicate your wishes in a clear manner.
Again, your changes must be made, signed and notarized according to the laws in
your state. Make sure that your doctor and any family members who knew about
your directives are also aware that you have changed them.
If you do not have time to put your changes in writing, you can make them
known while you are in the hospital. Tell your doctor and any family or friends
present exactly what you want to happen. Usually, wishes that are made in person
will be followed in place of the ones made earlier in writing. Be sure
your instructions are clearly understood by everyone you have told.