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Michigan Elder Law Today

Monday, November 19, 2018

Appropriate-Documents-For-End-of-Life-Care-Decisions

You may think your living will is in order, including instructions regarding resuscitation commonly referred to as a DNR (do not resuscitate). While your wishes in a living will may be appropriately documented, that does not guarantee the instructions will be carried out as you stated. The unfortunate truth is that mistakes about your end-of-life instructions are made while you are at your most vulnerable. 

The underlying problem is that doctors and nurses have little if any training at all in understanding and interpreting living wills, DNR orders, and patient advocate designations. Couple the medical professionals' lack of training with communication breakdowns in high-stress environments like a hospital emergency ward where life and death decisions are often made within minutes, and you have scenarios that can lead to disastrous consequences. 

In some instances, mix-ups in end-of-life document interpretation have seen doctors resuscitate patients that do not wish to be. In other cases, medical personnel may not revive a patient when there is the instruction to do so resulting in their death. Still other cases of "near misses" occur where problems were identified and corrected before there was a chance to cause permanent harm. 

There are some frightening worst-case scenarios, yet you are still much better off with legal end-of-life documents than without them. It is imperative to understand the differences between them and at what point in your life you may change your choices based on your age or overall health. To understand all of the options available it’s important to meet with trusted counsel for document preparation and to review your documented decisions often as you age. In particular, have discussions with your physician, your appointed medical decision-maker (called the patient advocate in Michigan), and your family about your end-of-life documents and reiterate what your expectations are. These discussions bring about an understanding of your choices before you may have an unforeseen adverse health event, and provides you the best advocates while you are unable to speak for yourself.

There are several documents that may be appropriate as part of your overall plan. Each of those are discussed below, and we are available to answer any questions you may have about them.

A living will is a document that allows you to express your wishes about your end-of-life care when any further treatment will just extend the process of dying. For example, you can document whether you want to be given food and hydration to be kept comfortable, or whether you want to be kept alive by artificial means.

A living will becomes activated when a person is terminally ill and unconscious or in a permanent vegetative state. Terminal illness is defined as an illness from which a person is not expected to recover even though they are receiving treatment. If your illness can be treated this would be regarded as a critical but not terminal illness and would not activate the terms of your living will.

Do not resuscitate orders (DNRs) are binding medical orders that are signed by a physician. This order has a specific application to cardiopulmonary resuscitation (CPR) and directs medical professionals to either administer chest compression techniques or not in the event you stop breathing or your heart stops beating. While your living will may express a preference regarding CPR it is not the same thing as a DNR order. A DNR order is specifically for a person who has gone into cardiac arrest and has no application to other medical assistance such as mechanical ventilation, defibrillation, intubation, medical testing, intravenous antibiotic or other medical treatments. Unfortunately, DNR orders may be wrongly interpreted by medical professionals to mean not to treat at all, so a properly drafted living will can help clarify this.  A property drafted patient advocate designation can include the power for the patient advocate to execute new DNRs and otherwise deal with the end-of-life situation if you are unable to do so due to your medical condition.

A patient advocate designation, sometimes referred to as a health care directive, allows you to name a patient advocate to make decisions for you if you are unable to. Unlike a living will which only covers end-of-life decisions, a patient advocate designation allows the agent to act at any time that you cannot make decisions for yourself.

Due to medical privacy laws, such as HIPAA, medical provides may not be able to release any information about you. To counter this problem, it is a good idea to execute a comprehensive authorization for release of protected health information, where you designate in advance the people you want to receive medical information about you in the event of your incapacity.

As an estate planning and elder law attorney, I can help you determine which documents best suit your current needs, and help you clearly state your wishes in those documents. I look forward to hearing from you and helping you with these important planning steps.


Attorney Andrew Byers' estate planning and elder law office is located in Troy, Michigan.


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