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Psyche
03-24-2005, 01:00 PM
Information I thought I would share...

From familydoctor.org: http://familydoctor.org/003.xml


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 followed.


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 state senator or state representative 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.

Psyche
03-24-2005, 01:02 PM
From the American Medical Association website: http://www.ama-assn.org/

http://www.ama-assn.org/ama/pub/category/8461.html


Do-Not-Resuscitate Orders

Efforts should be made to resuscitate patients who suffer cardiac or respiratory arrest except when circumstances indicate that cardiopulmonary resuscitation (CPR) would be inappropriate or not in accord with the desires or best interests of the patient.

Patients at risk of cardiac or respiratory failure should be encouraged to express in advance their preferences regarding the use of CPR, and this should be documented in the patient’s medical record. These discussions should include a description of the procedures encompassed by CPR and, when possible, should occur in an outpatient setting when general treatment preferences are discussed or as early as possible during hospitalization. The physician has an ethical obligation to honor the resuscitation preferences expressed by the patient. Physicians should not permit their personal value judgments about quality of life to obstruct the implementation of a patient’s preferences regarding the use of CPR.

If a patient is incapable of rendering a decision regarding the use of CPR, a decision may be made by a surrogate decision maker, based upon the previously expressed preferences of the patient or, if such preferences are unknown, in accordance with the patient’s best interests.

If, in the judgment of the attending physician, it would be inappropriate to pursue CPR, the attending physician may enter a do-not-resuscitate (DNR) order into the patient’s record. Resuscitative efforts should be considered inappropriate by the attending physician only if they cannot be expected either to restore cardiac or respiratory function to the patient or to meet established ethical criteria, as defined in the Principles of Medical Ethics and Opinions 2.03, "Allocation of Limited Medical Resources," and 2.095, "The Provision of Adequate Health Care." When there is adequate time to do so, the physician must first inform the patient, or the incompetent patient’s surrogate, of the content of the DNR order, as well as the basis for its implementation. The physician also should be prepared to discuss appropriate alternatives, such as obtaining a second opinion (eg, consulting a bioethics committee) or arranging for transfer of care to another physician.

DNR orders, as well as the basis for their implementation, should be entered by the attending physician in the patient’s medical record.

DNR orders only preclude resuscitative efforts in the event of cardiopulmonary arrest and should not influence other therapeutic interventions that may be appropriate for the patient. (I, IV)

Issued March 1992 based on the report "Guidelines for the Appropriate Use of Do-Not-Resuscitate Orders," adopted December 1990 (JAMA. 1991; 265: 1868-1871); Updated June 1994.

Rhia
03-24-2005, 01:25 PM
I downloaded the forms for A Living Will and Medical Power of Attorney earlier this week - printed a few copies, one for me, one for the rogues

http://www.peopleslawyer.net/deathdying.html

AllieSutherland
03-24-2005, 01:57 PM
Make sure that all of your doctors, local hospital, immediate family members (spouse, etc) get a copy and save it in your files or important papers.

Make sure that your copies are witnessed appropriately for your state (notary, hospital witness, etc).

Carry a note in your wallet saying that you have specific wishes, and how to contact those that have them.

MacKahlia
03-25-2005, 01:21 PM
my Dad is a medic and is getting D.N.R. tattooed on his chest.


just sharing.

Madame Maria
03-25-2005, 01:44 PM
Sadly, here in FL even if you have a DNR your family has the right to recind the order and request any/all life-saving procedures. :cry:

Besides making sure you have all the copies properly witnessed/notarized...from an EMS standpoint (I'm a medic) please, PLEASE make your loved ones aware of your wishes and impress upon them your desire to have them carried out to the letter.

:rant: Emotions run extremely high (unless there's a terminal illness involved (and even then)) and people tend to become selfish (sorry if I offend anyone -- I've seen it too many times, especially with people who ARE terminal -- family expects "life-saving" procedures -- and all you want to do is put your arms around them and say "Listen, everyone has to die. He/She is finally no longer suffering. Their pain has ended. If you didn't use this time to make amends or enjoy their last few days/weeks/months with them....sorry you wasted the time." Yes, it's harsh. Yes, it's cruel. But the reality is everyone has to die. Not everyone is meant to live a full life. Simply existing after having lived isn't an option for some people. I've transported many dying individuals and not one of them has ever said, "Yes, please, I want to be a burden on my loved ones & friends. I want them to see me suffer like no one else has. I want every extordinary effort made to keep my dying body alive so my family can continue to suffer long after I finally go. I'm going for the guilt factor here." Na-ah! I've been a medic now for 5 years and perhaps I'm cynical...but I prefer to believe that I'm more grounded in reality now than I ever was.

~~getting off soapbox~~ :sorry: Again, sorry if I offended anyone. I didn't really mean to. However this is a subject that is very close to my heart.

saphoenixsilver
03-25-2005, 02:00 PM
Sadly, here in FL even if you have a DNR your family has the right to recind the order and request any/all life-saving procedures.

I believe that this is true even in Texas. Luckily if anything were to happen to me the people who would be put in the position to make the decision KNOW that If I'm in a vegitative state or in any other way that I have no chance of recovering, I want them to let me go. We've discussed this between myself, my mother, and my sister to ensure that we all know exactly what to do if the worst happens. I'm with Madame Maria in making sure your family and loved ones know what you want, and stress how much you want it. It will be hard for them to let you go, but if you stress that that is what you want, they'll at least know that they respected what you wanted to happen.

Lady Sarah
03-25-2005, 02:14 PM
:rant: Emotions run extremely high (unless there's a terminal illness involved (and even then)) and people tend to become selfish (sorry if I offend anyone -- I've seen it too many times, especially with people who ARE terminal -- family expects "life-saving" procedures -- and all you want to do is put your arms around them and say "Listen, everyone has to die. He/She is finally no longer suffering. Their pain has ended. If you didn't use this time to make amends or enjoy their last few days/weeks/months with them....sorry you wasted the time." Yes, it's harsh. Yes, it's cruel. But the reality is everyone has to die. Not everyone is meant to live a full life. Simply existing after having lived isn't an option for some people. I've transported many dying individuals and not one of them has ever said, "Yes, please, I want to be a burden on my loved ones & friends. I want them to see me suffer like no one else has. I want every extordinary effort made to keep my dying body alive so my family can continue to suffer long after I finally go. I'm going for the guilt factor here." Na-ah! I've been a medic now for 5 years and perhaps I'm cynical...but I prefer to believe that I'm more grounded in reality now than I ever was.

You didn't offend me at all. I'm of the same mind. When it's time to go, let them go. It may be the hardest thing you'll ever do and you may mourn for years, doubt yourself and your decision, but in the end, it's better - IMHO, of course - to let them pass with dignity.

It's not the same, but when my mother's mother passed away, she couldn't be there. Looking back, a part of her wished she had been able to go back, say goodbye... but she knows that if she had, the pain-ridden and wasted image of her mother would be the last memory, not the playful memory of her turning her head over and sticking out her tongue at her. So many nights while her mother was fading, my mother prayed that she'd not wake up the next morning. Not to see her die, but to relieve her sister and her father of the stress and burden of caring for Grandma.

My parents have made it very and explicitly clear that if they survive any catastrophic event and are faced with life saving measures, weigh the outcome versus the longrun. If their survival means being hooked to tubes and IVs, don't. They don't want that and I know I couldn't stand to see them like that. That wouldn't be my parents.

Captain Stamina
03-30-2005, 03:51 PM
You may want to do a search for "Durable Power of Attorney for Health Care Decisions" since each state had different laws concerning this issue.

For Texas: http://www.texasprobate.com/other/stathcpo.htm