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Information from Your Family Doctor
Advance Directives and Do-Not-Resuscitate Orders
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Am Fam Physician. 2000 Oct 1;62(7):1683-1684.
What are advance directives?
Advance directives tell your doctor what kind of care you want if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the staff will probably talk to you about advance directives.
Effective advance directives describe the kind of treatment you would want for different levels of illness. For example, the directives would describe what kind of care you'd want if you had a critical illness, a terminal illness or permanent unconsciousness. Advance directives are often written to tell your doctor that you don't want certain kinds of treatment no matter how ill you are. However, they can also say that you do want a certain treatment.
Advance directives can take many forms. Laws about advance directives vary from state to state. You should be aware of your state's laws regarding the scope of advance directives and requirements that apply to them.
What is a living will?
A living will is a type of advance directive. It 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 or don't want in certain situations. For example, someone with terminal cancer might write that they do not want to be put on a respirator (breathing machine) if they stop breathing. This action can increase their control over their death and their peace of mind, and eventually reduce their suffering. Other treatments that may be covered by a living will include use of antibiotics, feeding tubes or surgery. However, a living will does not 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 like a living will, but it becomes active any time you are unconscious or unable to make medical decisions. In a DPA, you select a family member or friend who will be your medical decision-maker if you become unconscious or unable to make medical decisions. A DPA is generally more useful than a living will. However, if you don't have a person you trust to make these decisions for you, a DPA may not be a good choice.
Are living wills and DPAs legal in every state?
Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the laws of your state, they can still guide your loved ones and your doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the laws on living wills and DPAs in your state.
What is a do-not-resuscitate order?
A do-not-resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless they are given other instructions, hospital staff will try to help any patient whose heart has stopped or who has stopped breathing.) You can use an advance directive form to make this request or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical record 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 by their doctor. 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 have had a very bad stroke, 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 in the doctor's office or when you go to the hospital. It's best to do this early before you are too sick and are considered unable to make your own decisions by your doctor or your loved ones.
Who should have an advance directive?
Most advance directives are written by older or seriously ill people. However, you might want to consider writing an advance directive even if you are in good health. An accident or serious illness can happen suddenly. If you already have a signed advance directive, your wishes are more likely to be followed. Also, you can spare your family members the stress of trying to decide what you would want them to do.
How can I write an advance directive?
With the support and assistance of your doctor and your loved ones, you can write an advance directive in one of several ways:
Use a form provided by your doctor or a local hospital.
Call your state senator or state representative to get a form.
Call a lawyer.
Use a computer software package for legal documents.
Write your wishes down by yourself.
Advance directives 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's laws. Advance directives should be notarized, if possible, and copies should be given to your family and your doctor.
Can advance directives be changed?
Yes, advance directives can be changed. To do this, destroy all copies of your previous advance directive and create a new version. Notify your doctor and anyone else who has been involved in the process that you have changed your advance directive and submit the new version for your medical record.
This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
Copyright © 2000 by the American Academy of Family Physicians.
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