DNR and AMD

DNR – three little letters – so easy to say

But DNR is an acronym for Do Not Resuscitate, and that is a life and death matter. It seems to go against our very instinct for survival!

DNR is generally taken as a direction to medical staff that a patient does not wish to have cardiopulmonary resuscitation (CPR) if their heart stops or if they stop breathing. Unless given other instructions, hospital staff will try to revive any patient whose heart has stopped or who has stopped breathing. However, sometimes people who are critically ill with no hope of improvement would prefer to be allowed to die naturally.

How do you arrange a DNR instruction for medical staff? Do people really understand what it means and is their understanding the same as the medical profession’s? It is rather critical to make sure that there is no room for misinterpretation. The best way is to set up an Advance Directive, which is also known as a Living Will.

An advance directive lets your doctor know what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, say). 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. Although advance directives usually tell your doctor that you don’t want certain kinds of treatment they can also say that you do want a certain treatment no matter how ill you are.

You can only make an advance directive while you are of sound mind. A good advance directive describes the kind of treatment you would want depending on how sick you are.

Hospital staff will probably talk to you about advance directives if you are admitted to the hospital with a potentially life threatening condition. For example, someone who has been diagnosed with terminal cancer might decide that they do not want to be put on a respirator if they stop breathing. This decision can help reduce suffering and increase peace of mind by giving the person control over their own death. Of course, medical staff will still do their utmost to alleviate distressing symptoms with palliative and nursing care and by administering pain relief.

An advance directive only comes in to effect if you are not able to communicate or participate effectively in decisions about your medical care and treatment.  Also, two independent physicians have to be of the expert opinion that you are unlikely to regain a quality of life that you consider acceptable. You can specify the circumstances where that is to apply and you can appoint someone as your medical attorney to make those crucial decisions for you. You can change your mind about decisions you have made if you are still able to communicate so you are not stuck with the instructions written in your advance directive.

It is true that people who are seriously or terminally ill are more likely to have an advance directive. 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.

By creating an advance directive, you are making your preferences about medical care known before you’re faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick.

Your family and the medical profession are far more likely to appreciate an advance medical directive that has obviously been thought out rather than a simple DNR – Do Not Resuscitate notice – as an advance medical directive can be tailored to your specific medical circumstances.

End of life care is a hot topic and it all comes down to one word – communication. Make sure someone knows what your wishes are and it’s far easier for everyone involved if you have those wishes set down in writing in the form of an Advance Medical Directive.

An Advance Medical Directive is one of three documents every adult should have in place – the others are a Power of Attorney and a Will.Hastings Legal Lab

Hastings Legal are designated Solicitors for Older People Scotland in the Scottish Borders.

If you are too ill to come to us, don’t worry, one of our solicitors can visit you at home or in Hospital

What is an Advance Directive?

An Advance Directive is a clear statement in advance to your doctors and relatives as to your wishes regarding healthcare and treatment should certain extreme conditions arise.

For example, if you were in the very last stages of a terminal illness and got the flu it would probably end your life. Your doctor might suggest a course of antibiotics to extend your life by a few days or weeks. Many people, however, would not want this and choose to make their wishes known in advance. This can be done by preparing an Advance Directive.

Why do I need one?

If you were terminally ill, unconscious and unaware of what was happening around you with no hope of recovery, would you want the decision about whether to withdraw futile medical treatment to be put in the hands of a loved one? If you are unable to make decisions about your medical treatment, it is usually left up to your next of kin to make the decisions. A relative placed in this situation may feel troubled and even guilty over any decision they make. If you prepare clear instructions in advance it allows doctors and relatives to go along with what you want.