A good estate plan includes not just a Last Will and Testament, but a carefully thought out Medical Directive and Medical Power of Attorney. A Medical Directive can be more than just a Do Not Resuscitate order, or a “DNR.” Mindful planning can help you and your family make the right decisions for end of life care that minimizes pain for everyone.

Unrealistic Expectations and CPR

Because of a lack of education on CPR, many people have unrealistic expectations concerning both its effectiveness and the trauma and pain involved. Outside of the hospital, fewer than 10% of people survive, and this number falls to as little as 2% for those with preexisting heart, lung, or kidney disease. Many people are further surprised that CPR is painful for the recipient, who may face broken ribs, contusions, and other painful complications. Because of the painful nature of CPR, as many as half the patients who survive after CPR wish they had not received it. To determine whether CPR or other interventions are suitable for a person, they must have clear and honest communication with their doctor or medical professional. This becomes particularly vital after a person is diagnosed with a serious disease.

Medical Directives and Living Wills

Estate Planning should always include a medical directive or living will, after discussions with a doctor or medical professional. A medical directive is a set of instructions for healthcare in the event the patient is unable to communicate their wishes. A living will is a particular type of advance directive emphasizing end-of-life care. A well-written directive guides your doctors while preventing conflict and providing closure for family members.

A person should consider the following issues of care in their medical directive or living will:

• CPR
• Ventilation
• Dialysis
• Tube Feeding
• Palliative Care (care that keeps the patient comfortable and addresses pain)

In discussions with your doctor, you may need to take the lead and ask about how effective CPR or other interventions will be for you, given your age and medical condition. If your doctor is uninformed about these issues, it may be time to switch care providers.

Healthcare Power of Attorney

Some people choose to put medical decision-making in the hands of a trusted friend or family member through a Healthcare Power of Attorney. The person named to make medical decisions has many different titles in different states or healthcare facilities. You may have heard the terms healthcare surrogate, patient advocate, or healthcare proxy.

State Law/Multiple Homes

Requirements for advance medical directives vary by state—you may wish to discuss the requirements in your state with an attorney, which becomes vital if you live in more than one state or travel a great deal. So, if you live in New Jersey and Florida but spend lots of time in North Carolina with your grandkids, your advance directive should be flexible and portable.  In this situation, it’s common to execute several versions  of a medical directive, each tailored to the specific requirements of the state.

DNR Order During Hospitalization

Even if you do not have an advance medical directive or living will, you may communicate a wish not to receive resuscitation during a particular hospital stay. This wish is often respected by the physicians giving care, but to be safe, it is a good policy to put your wishes in writing before anticipated hospitalization. In a related matter, it may seem to you that someone in the hospital is always asking whether you have a medical directive or living will, and this may strike you as insensitive or even self-serving of the hospital. It may help to know that hospitals are obligated to ask about advance directives under the Patient Self Determination Act of 1990.

AND Increasingly Used Instead of DNR

Some patients or doctors prefer to use the approach of Allow Natural Death (AND) to a Do Not Resuscitate (DNR) order. AND emphasizes treating the pain and anxiety that a patient may experience while not resuscitating through CPR or shock therapy. The goal is to keep a patient in a natural environment (such as home or hospice), in a comfortable state, and allow death to occur naturally.

Estate Planning and Medical Directives

Talk to your doctor and then make a point of including medical decision-making as part of your estate plan. A good estate attorney will be open and well informed and strive to see that you have control over your own health care decisions.

For help with your estate planning questions, contact Melanie Levan at 856-354-7700 or mlevan@earpcohn.com.