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Misconceptions Regarding Advanced Directives and DNR Orders

United States Laws allow Advanced Directives (AD) in every state. Laws do vary from state to state as do forms. When looking at setting up an Advanced Directive or other healthcare orders, patients and families should look to local state agency sites for guidance.

What you allow is what will continue.


Basic Definitions:

  • Medical Proxy (Health Care Agent / Medical Power of Attorney) – a person appointed by a patient via a legal document that appoints someone to make decisions regarding medical medical care for the patient if the patient is no longer able to make those decisions. IF THE PATIENT IS ABLE TO SPEAK FOR HIM/HERSELF THEN THE MEDICAL PROXY CANNOT SUPERSEDE PATIENT WISHES. This document is legally binding and cannot be overturned later so choose the person wisely.
  • Living Will (Advanced Care Directive / Health Care Directive) – A legal document in which a person documents their wishes regarding medical treatment which is to be followed in case patient is no longer able to communicate their wishes. This is a legally binding document and should be completed with the assistance of an attorney or other healthcare professional so all possibilities are addressed.
  • Texas MOST Form (Other states have other abbreviations: POST, MOLST, MOST) – Medical Orders for Scope of Treatment Form is a state form used to document patient preferences. These forms can be limiting in some capacity but are good to have if full Advanced Directives are not completed.

Patients and Clinicians should begin advanced care planning BEFORE they become seriously ill. Having discussions early allows everyone to think clearly and talk about what they would like to happen if a situation should arise. Most patients are not thinking about this, and most of the time, primary care physicians or other clinicians should at least initiate the conversations. Patients and families should also take a proactive approach to their health care decision making and have conversations.

Medical Power of Attorneys are NOT financial power of attorneys. These are separate and different legal documents and usually do not cross unless clearly stated in legal paperwork.

One of the biggest misconceptions individuals have is that having a DNR order means clinicians will not treat a patient. Patients with advanced directive orders receive regular treatment and aggressive care as any other patient would. The Advanced Directives would only become effective when the patient is no longer able to speak for themselves AND the conditions specified in the Advanced Directives occur.

The role of becoming a medical health care proxy can be troubling and even traumatic for family members. Individuals should take the opportunity to have some of these difficult conversations with loved ones, especially if they have serious medical conditions to discuss what they would want and would not want. Loved ones will need to hear that if I am dying, you don’t need to prolong it. When do we stop, when have we done enough to stop? These are difficult conversations but will go a long way giving you peace of mind knowing your loved ones understand what you want as well as giving your loved ones clarity and reducing their anxiety.

Talking to your doctor and having these conversations is also a good idea. Just like you, physicians are people and they do not like talking about death and decline. Most will take the opportunity to hint at things to you, but if you bring up the topic, it gives them a green light to have a frank discussion with you. Give the permission to have these conversations with you. You will have a much better understanding of what is going on with your clinical care and will be glad you did.

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