Do Not Resusciate Orders and End of Life: When the Rubber Hits the Road
I don't even try to aspire to the blogging expertise of Wills Trusts and Estate Prof Blog. It's a great place for inspiration to do a blog post with my own take on things. This week there was a post on a Washington Post piece titled A patients death prompts a doctor to assess "Do Not Resuscitate" Order.
This doctor gave a front line opinion on DNRs (Do Not Rescuscitate orders) and DNIs (Do Not Incubate orders) These are not technically estate planning documents because they are not legal documents but medical orders obtained from your doctor. Yet they are often part of the estate planning conversation because they are the enforcement tools, if you will, for your advance directives. They help you or your health care agent communicate to your medical professionals what your wishes are as expressed in person or in your living will.
The doctor who wrote the article expresses a view that some DNRs are premature because even the terminally ill can be made comfortable and alert with less muss and fuss than many believe. On the other hand, I have a client who is an EMT on an ambulance who has insisted on a DNR since he was in his early 30s. Based on his experience in the emergency medicine field, he firmly believes that his life would not be worth living after resuscitation.
I've had plenty of conversations with family members who worked with medical professionals to interpret and carry out the wishes expressed in a living will. I know that these families rely heavily on the opinions of the medical professionals about what is best for a loved one.
I sometimes feel a major disconnect between the conversations I have with my clients about their end-of-life care and the actual real world experience that their families face when end of life decisions must be made quickly in the fog of loss and grief. I will have to enter into more dialogue with medical professionals so that my counseling time with clients is well-informed and even more useful.
This doctor gave a front line opinion on DNRs (Do Not Rescuscitate orders) and DNIs (Do Not Incubate orders) These are not technically estate planning documents because they are not legal documents but medical orders obtained from your doctor. Yet they are often part of the estate planning conversation because they are the enforcement tools, if you will, for your advance directives. They help you or your health care agent communicate to your medical professionals what your wishes are as expressed in person or in your living will.
The doctor who wrote the article expresses a view that some DNRs are premature because even the terminally ill can be made comfortable and alert with less muss and fuss than many believe. On the other hand, I have a client who is an EMT on an ambulance who has insisted on a DNR since he was in his early 30s. Based on his experience in the emergency medicine field, he firmly believes that his life would not be worth living after resuscitation.
I've had plenty of conversations with family members who worked with medical professionals to interpret and carry out the wishes expressed in a living will. I know that these families rely heavily on the opinions of the medical professionals about what is best for a loved one.
I sometimes feel a major disconnect between the conversations I have with my clients about their end-of-life care and the actual real world experience that their families face when end of life decisions must be made quickly in the fog of loss and grief. I will have to enter into more dialogue with medical professionals so that my counseling time with clients is well-informed and even more useful.
Posted by Karen Brady at 3/14/2010 7:34 AM 
Categories: Estate Planning
Tags: DNI end of life DNR living will estate planning health care powr of attorney advance directives health care directives Do Not Incubate Do Not Resuscitate medical power of attorney
Categories: Estate Planning
Tags: DNI end of life DNR living will estate planning health care powr of attorney advance directives health care directives Do Not Incubate Do Not Resuscitate medical power of attorney
Karen,
Thank you for a very thoughtful and insightful reminder about the disconnect between a client's intentions and what happens with these end of live decisions. If you have never had the opportunity to chat with Susan Fox Buchanan I would highly recommend it. Susan is a lawyer with two graduate degrees in medical ethics. She has become the expert, in my opinion, regarding the importance of assisting clients understand the practical and legal implications of end of life decision-making. I'd be happy to make a virtual introduction if you would like to initiate a conversation with her. I've found her to be highly collaborative and appreciative of opportunities to share her insights with other lawyers.
I've just begun following your blog and wish I would have started sooner. You re doing a marvelous job.
John A
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John A.,
Thanks for the kind words. I have crossed paths with Susan Fox Buchanan and still use some of the materials she developed back in the old days. Thanks for reminding me of how valuable she can be as a resource.
Karen
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A do not resuscitate document is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Abbreviated DNR, such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy.
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