Understanding Advance Directives

As readers of this blog know, I strongly encourage my clients, groups that I have the opportunity to speak with, and my friends and family to prepare advance directives so that they can make their own decisions about what medical care they do, or do not, want to if they are unable to communicate that decision. 

I recently received this article by Dr. Nathan Laufner, President of the Maricopa County Medical Association. Dr. Laufner cautions that Living Wills and Do Not Resuscitate (“DNR”) Orders are frequently misunderstood, both by the individual and the medical personnel who need to rely on it.  For example, the individual may have one thing in mind when he says that he does not want treatment if he has a terminal illness, but his doctor may interpret that differently. (See Dr. Laufner’s article at http://www.mcmsonline.com/president/nathan-laufer-md/do-not-resuscitate-orders-lets-prolong-life-not-prolong-death.)

Living Wills and DNR Forms do raise complex and often confusing issues.  As Dr. Laufner points out, the hospital personnel who give these forms to patients as they are being admitted may not be equipped to answer the patient’s questions, not to mention the impact of all of the emotions that person may be feeling at that time. This is why I recommend that these forms be completed in advance of any particular illness or hospitalization, when a person has time to think about what they want and confer, sometimes more than once, with family members and loved ones.

Dr. Laufner also says that, when patients hand doctors Advance Directives that they have completed previously, they often don’t understand what they mean. While “self-service” forms, available from many private organizations or state attorneys general, are certainly better than nothing, Dr. Laufner’s observation highlights the importance of working with an elder law or estate planning attorney when preparing these forms. The attorney will take the time required to explain the meaning of the various options, and is the advocate for the individual, not his family or his health care providers, who, while well-meaning, may have different perspectives and interests.

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