An advance medical directive is something entirely different than a physician's "Do not attempt resuscitation" order entered into your medical record once you are in the hospital. They have very different rules. MDinana is entirely correct that a physician's DNAR may not be honored elsewhere, and it will likely to cease having any effect once you are discharged.

But, an advance medical directive, properly prepared and legally sufficient, is a binding legal document. It must be honored at ANY hospital. If some hospital refuses to honor one of my client's directives simply because it's not on their own form, I'll have their posterior in front of a judge so fast their heads will spin, and that's one advantage of having a lawyer prepare the document with you. Mine have my after hours cell phone printed on it for just such emergencies, along with many other provisions covering all sorts of circumstances that I've not seen anyone else include.

Also, because they have neither the time nor the ability to review the legal sufficiency of your advance medical directive in an out of hospital emergency, paramedics in most jurisdictions are trained to simply ignore it, and let the hospital folks sort it out. However, as MDinana correctly points out, some jurisdictions have special out of hospital forms aimed at paramedics. Florida does. Check for this in your jurisdiction.

MDinana gives wise advice to "make sure you understand the legalities in your area about when it does and doesn't apply." The rules can vary in different jurisdictions. I'm not offering legal advice here, just information for you to discuss with your own attorney familiar with your jurisdiction.

Jeff

Doug,
First, my condolences

RE Living wills, DNRs, healthcare proxies etc

They are state specific, and talk with a lawyer. I've gon through this twice in the last 13 months (Mom then Dad). Got to talk to the Hospic folks (GREAT folks- at least around here)

If you have ANY, and I mean ANY health issues - do yourself a favor. Write down your medical history, plus what drugs and dosages you take, plus any medical care instructions (DNRs, proxies, etc) put them in an envelope, with a BIG label "Name's Healthcare info", put in a ziplock bag, and stick it to the front/side of your REFRIGERATOR where it can be seen

The FDNY/EMS crews say "we find you on the floor, unresponsive, the first place we're going to go is to your refrigerator to look for drugs - insulin etc. We'll see that envelope, and be REALLY happy to have it"

I carried a copy of Dad's medical history, his prescription list, all his MD and insurance info and the like on a small slip of paper in my wallet (in like 3-4 point type), plus a copy on my thumb drive. Over the last 6-8 months of his life, as he shuffled in and out of hospitals, nursing homes, rehab centers, etc, the doctors were all so happy that I could hand them that piece of paper. It took care of the immediate needs, and gave them people/places to contact for the more advanced info (like complete records). I can remember walking into the hospital the first time in the whole chain, and the admitting nurse being so happy to get that paper when she started asking medical history questions

I carry a similar slip for ME, easy to find in my wallet, and one for my wife, and the kids that are burried to they are not confused with mine

I am sorry for your loss. But you/he did the right thing. Quality of life, in my opinion, is everything. He had obviously come to the same decision.

Re living trusts, they are indeed great. They do not solve all problems, but they sure do smooth out the road. My parents had one, which really simplified things for me once they were gone. We have one too, but since we just changed state residences, we have to have another drawn up. Thanks for the AARP hint, I did not know that.

Re DNR's, in my experience, there are hospitals, probably all of them, that will only accept a DNR that is on THEIR form. They will ignore anything written by your attorney, or anyone else...

First of all, my condolences to Doug and his family.

I would urge everyone, this being a forum about Survival, to be very very careful how you use terms like "Quality of Life" Honestly, the last thing I'm worried about is being given life prolonging treatment that I don't want. I'm much more concerned about being denied even the most basic care that I do want. They don't call it the "culture of death" for nothing.

From http://www.nrlc.org/euthanasia/AdvancedDirectives/ReportRevised2007.pdf

From a survival perspective, think about how many people in survival situations had an absolute zero quality of life and a zero hope for rescue. Yet they kept on going. How many of us would have judged their lives unworthy of living at the time?

When my Mom had to go into the hospital in the last few years of her life, almost the first words out of the mouths of the people in the hospital were "Do you have a Living Will?"

Maybe I am being cynical beyond all redemption (really?), but I kind of got the impression that they would be perfectly happy not to attempt to resusitate if no one was going to pay for it.

Unfortunately, a few other people going to this hospital chain have gotten the same impression.

I was also told by an attorney in Las Vegas that without a medical power of attorney, NO ONE except a current spouse can make medical decisions. It doesn't matter if you are blood child, sister or father. If you don't have the paperwork, you can't make the decisions that you know the person wanted; the hospital will make them, right or wrong.

Sue

When my mom was dieing in the hospital, even tho we had a living trust, durable power of attorney for health care, DNR, etc etc etc, her dr made me hand write a document, at oh dark thirty, telling him to unplug her. I did it, he did it, next morning he plugged her back in, pretty much all by himself. More money for those twice a day five minute visits to her room for him...

It appears your mother's physician committed criminal battery under state law, a violation of federal law, as well as a huge ethical breach and probably a violation of your state's medical practice act, not to mention possible insurance and/or medicare fraud. Having you write out your instructions was merely prudent, however. That's what I'd advise any of my doctors to do, in any such case.

These posts make it sound that doctors nation-wide are out of control. It worries me.

Jeff

Doug; our condolences to you and your family.





I used a similar approach in Virginia with my Dad and his DNR order. He was at home, in home hospice, and we posted it on the refrigerator door. It was an ugly orange color so no one would overlook it. We also stopped by and talked to the guys in the local EMS squad, and briefed them. They made a note of it in their log book/notes, so even the off-duty guys would know to look for the order in case they responded.

The help of locally knowledgeable folks is invaluable in being sure the documents are accepted and implemented. One resource is your local hospital's medical social worker (may have different title) who probably knows all of the ins and outs and can get you started in the right direction.

For once, maybe Florida is a leader instead of behind the times. Actually, Florida does have some pretty darn good laws in the area of elder rights and protections.

Now, I need to make a clarification. There is a huge difference between refusing to honor the decision of a patient or surrogate just because their instructions are written on the wrong "form" one the one hand, and merely requesting that patients or their surrogates reduce their instructions to writing on a specific form that is familiar to them and therefore easier for them to follow, while fully intending to honor and comply with all of the instructions and decisions of the patient or surrogate, whatever they may be, on the other hand.

As long as they are doing what the patient or surrogate directs, there's no problem with them saying "Okay, we'll do as you say, but please just put it in writing on the form our folks are used to, so there are no mistakes about you want us to do."

We are discussing something very fundamental here, and that is the right to self-determination and to control one's own body and destiny, either for ourself or through another trusted person we've selected to speak for us when we longer can. This is perhaps the most basic right and freedom of all. If that right is not being respected by the medical community, or by your or your loved one's physician, then something, somewhere, has gone seriously wrong. You don't have to take it, and decisive and immediate corrective and enforcement action is called for.

Jeff