Hyden, Miron & Foster, PLLC Law Blog

Friday, March 18, 2016

End-of-Life Medical Decisions as Part of Estate Planning

What is the difference between a medical directive and a DNR?

Sometimes the most difficult part of estate planning is making decisions about how you want to be treated at the end of your life. Though we all know we are mortal, these decisions force us to confront some unpleasant possibilities. Still, making end-of-life decisions can provide reassurance, giving you the peace of mind that comes from knowing your wishes will be followed when you can no longer make yourself heard.

What is a Living Will?

A living will is an important part of estate planning. Since most of us do not die "peacefully in our sleep" without prior illness or injury, we need to make arrangements regarding precisely which types of medical care we wish to receive when we are seriously ill and approaching the inevitable.

If a person is terminally ill, death is expected to occur within a relatively short period of time. In such situations, providing medical care will simply prolong the dying process, not help to provide any kind of quality of extended life. In such cases, individuals have the prerogative to refuse medical care that would artificially prolong their lives.

There is an essential difference, however between medical care that would force the body to stay technically alive, and palliative care that will keep the patient as comfortable as possible during the dying process. Most people, no matter what their feelings about futilely extending life, opt for palliative care to keep them as pain-free as possible at the end of their lives.

What is a DNR?

A DNR, or do not resuscitate order, is a legal document designed to keep a dying patient from being resuscitated if he or she goes into cardiac arrest or stops breathing. It is basically an agreement between the patient and the medical establishment (doctor, hospital, nursing facility or hospice) stating that the patient does not wish to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) if their body goes through a sudden life-threatening event.

The major difference between a living will and a DNR is that the former is a legally binding document that the person signs, frequently during the estate planning process, and the DNR is a medical order.

Procedures Denied by a DNR

With a DNR document in place, patients will not receive: chest compressions, ventilation, defibrillation, endotracheal intubation, or medications to revitalize them. Relief of choking caused by a foreign body is typically an exception, since it is creating a painful, terrifying situation for the patient. Treatment is also given for painful breathing, injuries and hemorrhage. The rationale is that the patient does not want his or her life prolonged, but is not consenting to a tortured ending.

The Choice Is Yours

Though it is unpleasant to contemplate your own death, it is gratifying to be able to make advance decisions about one's own future care.  Contacting a qualified estate planning attorney is a good first step toward self-determination, not only in how your assets are distributed, but in how you are medically treated at the end of your life. Remember that the choice is yours. If you want your life extended under any circumstances, you certainly have the right to make this clear in your estate plan.


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