DEBORAH, HER MOM, AND DOING THE RIGHT THING
President of American Life League
Member of HALO’s Board of Advisors
My mom has stage 4 cancer, so I took one of the American Life League Loving Wills I got several years ago and read her the form about food and water and asked if she wanted to sign one so they will have to give her nutrition. She said she wanted to. My daughter is a notary, and she came to the hospital and read over the form. She said it wasn’t sufficient because it didn’t go into detail about DNR (Do Not Resuscitate) order. She notarized it anyway, but I need your input to make sure this is all we need.
Many people, often under the guidance of their lawyer, have living wills which specify what type of medical treatment they wish to have or forego should they have a terminal illness. There are several problems with this. First, the living will is a rather rigid document, often prepared years prior to the occurrence of the patient’s first medical illness, after which circumstances and opinions have often changed. Second, many physicians interpret a living will as a “do not resuscitate (DNR)” order, so that, if you are admitted for a non-terminal illness, you could be categorized as a DNR patient, when that may not be your wish. Third, patients with living wills, in general, will get less aggressive hospital treatment. My advice is to speak with a trusted friend or family member and make them your power of attorney for healthcare decision maker instead of obtaining a living will.
When it is directed by a dying patient or the patient’ s proxy that a gravely burdensome treatment will not be administered, a specific order for that specific non-treatment must be written. Written orders must be as precise as possible. “Do Not Resuscitate” or “No Code” are examples of ambiguous orders widely accepted by physicians and courts. Do these orders mean no maintenance of an airway, or no ventilation, or no cardiac resuscitation, as well as no new or additional therapy? Furthermore, in light of the weakness of human nature, once the course has been plotted by a DNR (“Do Not Resuscitate”) or a “No Code” order, there is a tendency to preclude, eliminate, or reduce other kinds of “ordinary” treatments, such as visits by physicians and care given by nurses and others. Broad orders of “Do Not Resuscitate” (DNR) or “No Code” must be avoided. At no other time in medicine are treatment-orders that are broad and non-specific considered to be within the standard of care.
Most states do not require a particular form, but they do have witnessing requirements or other special signing formalities that should be followed.Even if your state requires a specific form, doctors have a legal obligation to respect your clearly communicated treatment wishes in any manner or form expressed, as long as the wishes are medically appropriate. https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_37/issue_1_october2015/myths_and_facts_advance_directives/