American Medical Association Family Medical Guide - American Medical Association [308]
A living will is prepared when a person is still able to make decisions about medical care. However, it is activated only when the person can no longer make decisions or communicate his or her preferences about treatment. A living will may be changed or withdrawn (revoked) by the person whenever he or she chooses. The requirements for and legal authority of living wills vary from state to state; a living will that is legally binding in one state may not be binding in another. Therefore it is a good idea to consult a lawyer when preparing a living will.
Do-not-resuscitate order
A do-not-resuscitate (DNR) order is a doctor’s order stating that CPR should not be initiated if a person’s heart stops beating. A DNR order can be included in a living will. Without a written DNR order signed by a doctor, all medical personnel are required to begin CPR and take other lifesaving measures (such as attaching the person to a ventilator, which takes over breathing) if the person’s heart stops beating.
If a person is no longer competent, a family member (or health care agent) can request a DNR order. A DNR order can be prepared and issued by a doctor after discussions with the person who is ill and his or her family members or health care agent. In a hospital setting, only the person’s doctor signs the DNR order. A DNR order can be withdrawn at any time by the doctor. Copies of the doctor’s written DNR order should be kept in the person’s medical record at a hospital, nursing facility, or home health care agency.
Durable Power of Attorney for Health Care
A durable power of attorney for health care is a legal document in which a competent person gives another person (called a health care agent) the authority to make medical decisions on his or her behalf. The agent may be a relative, friend, lawyer, or guardian. A durable power of attorney for health care may also name a second and third alternate agent. The health care agent has the right to make all decisions about the person’s health care, to access medical records, to consent to or refuse any treatment, and to withdraw life-sustaining treatment. The health care agent also has the authority to donate the person’s organs or tissues (see previous page). A health care agent is required to exercise good judgment in accordance with the person’s wishes.
The person can withdraw the durable power of attorney for health care at any time. A durable power of attorney for health care goes into effect only after the person is no longer competent to make his or her own medical decisions.
A durable power of attorney for health care is different from a durable power of attorney. A durable power of attorney is a legal document in which a competent person gives an agent the authority to make legal or financial (rather than medical) decisions on his or her behalf.
Palliative Care
It is rarely true that nothing can be done for a terminally ill person when curative treatment is no longer appropriate. Along with understanding and comfort, a dying person needs relief from symptoms, especially pain. This type of care is called palliative care. Some hospitals have palliative care programs or trained staff members who can help keep a terminally ill person comfortable and try to fulfill the wishes and needs of the person and his or her family. Palliative care can take place in the terminally ill person’s own home or in a homelike setting (called