Knowing What the Patient Wants: Healthcare Directive, Living Will, and Do Not Resuscitate (DNR)

The issue of exhaustive yet routine and expensive medical treatment versus quality of life for patients at end-of-life has been a hot topic in the media recently. The St. Louis Post Dispatch ran a series of articles including “Woman’s 6-month decline highlights end-of-life care quandary.” The June addition for Time Magazine featured “The Long Goodbye.”

Both articles focus on family members deciding how much care is appropriate and what happens when medical care results in a quality of life that the recipient of the care may not have wanted.

What is apparent from these articles is that end of life issues are difficult to discuss with family members. As a result, individuals often lack the motivation to consult with counsel to make sure that their wishes regarding their medical care – particularly at end-of-life – are expressed in writing.

An individual may end up receiving long, drawn out treatment and a quality of life they did not desire.

Healthcare Directives, Living Wills, and Do Not Resuscitate (DNR)

In both of the examples, the families were aware of the wishes of the family member to some extent, and had even taken some measures to make appropriate decisions regarding their care.

However, problems arose when prolonged, “routine” care that was not considered aggressive or life-saving was undertaken and caused a great decrease in the quality of the patients’ lives. Neither patient had expressed in writing their wishes about such prolonged care, nor were they clear with their families as to when they would want to stop or refuse such care, such as a feeding tube.

Navigating how to express wishes regarding medical care in writing can be difficult.

Often, individuals request a DNR to express their wishes to not be kept alive on life support. A DNR is typically only executed for a chronically ill patient who does not wish for CPR to be issued if they go into cardiac arrest.

A Living Will is an expression of the patient’s wishes that if they are in a terminal condition, they do not wish for life-prolonging measures to be utilized.

Healthcare Directives are documents that specifically state what the patient wants in terms of care. For example, if the individual is in a terminal condition, a healthcare directive will often state the patient does not wish for a feeding tube to be inserted.

A Healthcare Power of Attorney works in conjunction with the Living Will or Healthcare Directive to appoint a friend or family member to make end-of-life decisions on the patient’s behalf. It is important to for the individual to discuss specifically what type of medical treatment the individual would want with the healthcare power of attorney.

For families making end-of-life decisions on a family member’s behalf, having a Living Will or Healthcare Directive in place can bring the peace of mind that is desperately needed in that situation.

When wishes are expressed in writing, the family can know they made the decisions that their loved one wanted them to make.