Pro-Life Issues
End-of-Life Directives
Unfortunately, many people who are seriously ill fear a painful or prolonged death more than the loss of their life. The fact is, no one today needs to die in pain and suffering, and no one needs to receive unnecessary medical care.
Recent medical studies have shown that almost all pain problems can be managed to a reasonable comfort level through the use of pain-relieving medications provided by knowledgeable healthcare professionals.[1]
Many options exist for patients to decide exactly what kind of medical care they will receive and what care they will not receive. From the simplest DNR (Do Not Resuscitate) orders for people who elect not to have CPR or be placed on a ventilator, to POLST forms, to Advance Directives such as Living Wills and Durable Power of Attorney for Health Care, everyone can and should discuss with their family members and their doctor what kind of care and intervention levels they want, so that they do not find themselves receiving care they would not have chosen.
POLST forms (Physician Orders for Life Sustaining Treatment) are documents that translate the wishes of patients with advanced illness into actual physician orders that can limit or expand the kind of care the patient receive. For example, a patient might elect to receive antibiotics and IV fluids but might decline to go on a ventilator. The Washington State Medical Association maintains helpful information about the POLST form.
Advance Directives tell a doctor what kind of care a patient would like to have if he or she becomes unable to make medical decisions (in a coma, for example). If someone is admitted to the hospital, the hospital staff will probably talk to them about advance directives. Advance directives include Health Care Directives (Living Wills), Do Not Resuscitate Orders, and Durable Powers of Attorney for Health Care.
A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don't want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.
A Durable Power of Attorney for Health Care is a legal document which allows you to name a person as your health care agent - someone who is authorized to consent to, stop or refuse most medical treatment for you, if a physician determines that you cannot make these decisions yourself. Once appointed, your health care agent can speak on your behalf anytime you are unable to make your own medical decisions, not only at the end of life.
A health care directive, commonly referred to as a 'living will', is a legal document specifying your wishes regarding the care you receive at the end of life should you be unable to communicate them. Health care directives may also be called a directive to a physician, declaration or medical directive. A living will doesn't let you select someone to make decisions for you.
There are federal and state laws that govern the use of advance directives. The federal law, the Patient Self-Determination Act, requires health care facilities that receive Medicaid and Medicare funds to inform patients of their rights to execute advance directives. All 50 states and the District of Columbia have laws recognizing the use of advance directives.
While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign it in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law. Also, advance directives can have different titles in different states. (You can download your state's advance directives here.)
1 Elliott, T.E., "Pain Control at the End of Life", Minn Med. 1997
