Some of my patients come in frequently from nursing homes, and even though we have documented on a living will their wishes and they have been DNR status on previous admissions, they are still a full code until the doctor writes that magic "DNR" order for that current admission.

The living will or advanced medical directive is only documentation of the patient's wishes and the patient is always a full code until the physician writes "Do No Resucitate" for that admission.

I've had patients that changed their minds and wanted to be full codes on subsequent admissions.

Keep in mind that a DNR order (at least in LA) becomes null and void if one family member objects (even an estranged adult child that hasn't had contact in years).

I've had that happen and it wasn't pretty.

It was one of those Jerry Springer smack-down moments with the crash cart in the middle until we got family out of the room.

Because of that I'm really pro-active in making sure that all family members involved are on the same page (which takes some doing).

Tell your family (even the ones you don't like because they're the ones that are going to cause the problems) what you're wishes are regardless of your age (MVA's happen) and put it in writing.

The living wills aren't a legally binding contract but they are hard proof for your loved ones of what you want or don't want done.

(Picture a distraut wife in the ICU waiting area in the middle of the night saying "I remember Skippy talking about that but I can't remember exactly what he said...." )

It sure can save a lot of grief and guilt for the loved ones in making the decision to have the physician make someone DNR.

I've had families that felt that by agreeing to have their mom made DNR that they were signing her death warrant which is of course not the case.

They were simply sparing their mom a lot of torture when the end result was going to be the same.